Navigating Methemoglobinemia: A Sodium Nitrite Poisoning Case Report and Therapeutic Considerations

Abstract

Incidences of sodium nitrite poisoning have frequently increased in the last few years with the wide, easy availability of the drug and the increase in suicidal tendencies in the population. Sodium nitrite is widely used as a food preservative and in treating cyanide toxicity. It is a powerful oxidizing agent, which oxidizes hemoglobin to methemoglobin, reducing the oxygen-carrying capacity of erythrocytes and causing tissue hypoxia. Patients with sodium nitrite toxicity present to emergency with hypotension, cyanosis, hypoxia, altered consciousness, dysrhythmia, and cardiac arrest. We report a case of a suicide survivor who presented with an intentional fatal overdose of sodium nitrite in an 18-year-old female by drinking approximately one tablespoon of sodium nitrite in a suicidal attempt. Upon arrival at the emergency department (ED), the patient was hypotensive, cyanotic, and cyanosis non-responsive to oxygen therapy. Hospital professionals should consider sodium nitrite toxicity in patients with a suspected overdose who present with a cyanotic appearance and pulse oximetry that remains around 85% despite oxygen and dark brown blood seen on venipuncture. Prompt diagnosis is crucial to start early treatment.