Discussion of analytical and interpretative aspects of nitrite intoxication in 12 forensic cases. In recent years, a significant increase of reports about suicidal cases due to intentional sodium nitrite intake has been described. Also, accidental poisonings can occur by exposure to contaminated food due to the use of sodium nitrite as a coloring agent or preservative in food, as well as an antimicrobial agent in meat and fish. The human toxicity of nitrite is mainly related to its capability to oxidize the Fe2+ of the hemoglobin to Fe3+, thus converting hemoglobin to methemoglobin, which is unable to bind and transport oxygen. The determination of nitrite in blood is challenging since it is rapidly oxidized to nitrate by hemoglobin. Thus, the diagnosis of nitrite intoxication is generally based on methemoglobin quantification. However, methemoglobin is only an indirect non-specific evidence of nitrite intoxication, as increases of this form of oxidized hemoglobin can be observed in different genetic defects and acquired conditions, including treatment with drugs. Consequently, a specific diagnosis of nitrite intoxication can be achieved only by the direct identification and measurement of the toxic compound or its derivatives. Recently, our research group validated a capillary electrophoresis (CE) method specifically devoted to the direct determination of nitrite/nitrate in biological fluids including postmortem blood (Taus F, et al. Forensic Sci Int 2021;325:110855). The aim of the present study was the discussion of analytical and interpretative aspects of 12 forensic cases of intentional and unintentional nitrite intoxication ( n = 4 fatalities; n = 3 suicidal attempts and n = 5 food intoxications). An automated capillary electrophoresis system Capel-205 (Lumex Instruments, Vancouver, Canada) equipped with a spectrophotometric detector was used. The analyses were carried out on a bare fused-silica capillary (75 mm inner diameter) using 100 mM tetraborate (pH 9.24) as background electrolyte and applying a voltage of - 15 kV. The detection was obtained by direct UV absorption recorded at 214 nm wavelength. All the biological samples (blood, urine and vitreous humour) were, after centrifugation, diluted 1:20 with the internal standard solution (Bromide: 250 μmol/L) prior to injection. Nitrate concentrations in blood ranged from 1400 to 6500 μmol/L in fatalities and from 910 and 2590 μmol/L in the suicide attempts. In food intoxication cases nitrate was always below 400 μmol/L. Nitrite was found only in not quantifiable traces due to its rapid conversion to nitrate. No interferences were observed from sample components, including proteins and ions. The proposed CE method allows for the direct and specific determination of nitrite/nitrate in different biological samples (serum/plasma or urine) as well as in postmortem specimens (cadaveric blood and vitreous humor). These characteristics, in addition to the speed and cheapness of the analysis, make this novel approach particularly suitable for the reliable diagnosis of nitrite intoxication in both clinical and forensic cases.
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