title: Multiple poisonings with sodium azide at a local restaurant.
abstract: BACKGROUND
  Sodium azide is a chemical with a mechanism similar to cyanide. There is concern that it could be used as a chemical warfare agent.
  
  
  OBJECTIVE
  We report a cluster of poisonings that occurred at a public restaurant and the subsequent investigation that identified iced tea contaminated with sodium azide (NaN3) and hydrazoic acid, as the foodborne vehicle and agents, respectively.
  
  
  METHODS
  Five patients became ill within minutes of drinking iced tea at a restaurant. They all presented to the same Emergency Department with similar symptoms, and improved with fluids, antiemetics, and supportive care. A joint investigation by the Dallas County Department of Health and Human Services, the Texas State Health Department, the Dallas County Southwestern Institute of Forensic Sciences, and the medical toxicologists at the University of Texas Southwestern School of Medicine identified iced tea, contaminated with sodium azide (NaN3) and hydrazoic acid, as the foodborne vehicle and agents, respectively.
  
  
  CONCLUSIONS
  The recurrence, and seriousness, of these events suggests a need for continued education of emergency providers. Emergency physicians should consider exposures to toxic chemicals in their differential when a cluster of patients presents with similar symptoms over a short period of time.
authors.affiliation: Division of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Evan S
authors.initials: ES
authors.lastname: Schwarz
authors.affiliation: Division of Emergency Medicine, University of Texas Southwestern School of Medicine, Dallas, Texas.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Wax
authors.affiliation: Division of Emergency Medicine, University of Texas Southwestern School of Medicine, Dallas, Texas.
authors.forename: Kurt C
authors.initials: KC
authors.lastname: Kleinschmidt
authors.affiliation: Division of Emergency Medicine, University of Texas Southwestern School of Medicine, Dallas, Texas.
authors.forename: Kapil
authors.initials: K
authors.lastname: Sharma
authors.affiliation: Department of Pediatrics, University of Texas Southwestern School of Medicine, Dallas, Texas; Dallas County Department of Health and Human Services, Dallas, Texas.
authors.forename: Wendy M
authors.initials: WM
authors.lastname: Chung
authors.affiliation: Dallas County Department of Health and Human Services, Dallas, Texas.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Cantu
authors.affiliation: Dallas County Southwestern Institute of Forensic Sciences, Dallas, Texas.
authors.forename: Erin
authors.initials: E
authors.lastname: Spargo
authors.affiliation: Dallas County Southwestern Institute of Forensic Sciences, Dallas, Texas.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Todd
mesh_terms: D000328:Adult; D001386:Azides / Q000032:analysis / Q000506:poisoning*; D004196:Disease Outbreaks; D005260:Female; D005506:Food Contamination; D006801:Humans; D008297:Male; D008875:Middle Aged; D012147:Restaurants; D019810:Sodium Azide / Q000032:analysis / Q000506:poisoning*; D013662:Tea / Q000737:chemistry*; D013781:Texas / Q000453:epidemiology; D014665:Vasodilator Agents / Q000032:analysis / Q000506:poisoning*
chemical_list: D001386:Azides; D013662:Tea; D014665:Vasodilator Agents; C007972:hydrazoic acid; D019810:Sodium Azide
keywords: hydrazoic acid; metabolic inhibitors; poisoning; sodium azide; terrorism