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Fatal methaemoglobinaemia induced by self-poisoning with sodium nitrite.

Abstract
Inadvertent ingestion of sodium nitrite is known to precipitate metheamoglobinaemia. No cases exist, however, of intentional suicide by methaemoglobinaemia following self-poisoning with sodium nitrite. A 76-year-old man collapsed and rapidly developed brady-asystolic cardiac arrest 25 min following self-poisoning with an unknown quantity of crystalline sodium nitrite. On arrival in the ED the patient was asystolic with cardiopulmonary resuscitation in progress. Haemoglobin concentration was 110 g/L, arterial methaemoglobin measured 82.6% and serum lactate 9.6 mmol/L. Antioxidative treatment was undertaken with total 5 mg/kg intravenous methylene blue administered in divided aliquots. Despite prolonged resuscitative efforts the patient died. Resuscitation from methaemoglobinaemia-induced asystole following self-poisoning presents a unique therapeutic challenge. Treatment of methaemoglobinaemia-induced cardiovascular instability and overt cardiopulmonary arrest are discussed.
AuthorsMartyn Harvey, Grant Cave, Giles Chanwai
JournalEmergency medicine Australasia : EMA (Emerg Med Australas) Vol. 22 Issue 5 Pg. 463-5 (Oct 2010) ISSN: 1742-6723 [Electronic] Australia
PMID21040485 (Publication Type: Case Reports, Journal Article)
Copyright© 2010 The Authors. Emergency Medicine Australasia © 2010 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.
Chemical References
  • Carcinogens
  • Nitrates
  • sodium nitrate
Topics
  • Aged
  • Carcinogens
  • Fatal Outcome
  • Humans
  • Male
  • Methemoglobinemia (chemically induced)
  • Nitrates (poisoning)
  • Suicide

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