Fatal methaemoglobinaemia induced by self-poisoning with sodium nitrite.
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.
Waikato Hospital, Lower Hutt, New Zealand. harveym@waikatodhb.govt.nz
Martyn
M
Harvey
Grant
G
Cave
Giles
G
Chanwai
D000368:Aged; D002273:Carcinogens; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008708:Methemoglobinemia / Q000139:chemically induced*; D009566:Nitrates / Q000506:poisoning*; D013405:Suicide
D002273:Carcinogens; D009566:Nitrates; C031618:sodium nitrate