Suicide of an adolescent girl with sodium nitrite ordered on the internet.
Raman spectrometry
X-ray diffraction
lethal white powder
sodium nitrite
suicide kit suicide methods among young people
Journal
Journal of forensic sciences
ISSN: 1556-4029
Titre abrégé: J Forensic Sci
Pays: United States
ID NLM: 0375370
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
revised:
13
07
2023
received:
25
04
2023
accepted:
19
07
2023
medline:
27
10
2023
pubmed:
1
8
2023
entrez:
1
8
2023
Statut:
ppublish
Résumé
Nitrites are commonly used in the chemical, pharmaceutical, and food industries. Recently, they have been identified in cases of voluntary intoxication. We report the case of a 13-year-old girl who was found lifeless on her bed next to a glass containing a white powder and a bottle containing a white powder with a moistened appearance. External examination and autopsy revealed a nonspecific asphyxia syndrome, which was confirmed by the pathological analysis. Analysis of the samples revealed metoclopramide in the peripheral blood at a concentration of 0.402 mg/L (LC-HRMS). An analysis of the gastric contents was carried out after sodium nitrite was detected in the powders found near the body (Raman spectrometry). Nitrites were found in the gastric fluid at a concentration of 30.9 mg/L. Death occurred secondary to anoxia, following ingestion of nitrites; suicide kits are available on the web and nitrites are relatively easy to source and inexpensive. Nitrites are delivered in powder form to be dissolved in liquid, which may then be consumed with metoclopramide (or an alternative anti-emetic drug) to maximize absorption and reduce emesis. The toxic effect of nitrites lies in their oxidizing power, causing the transformation of hemoglobin into methemoglobin, which, when it accumulates, induces tissue anoxia resulting in death. There has been an alarming increase in the number of cases linked to suicide using nitrites or a nitrite suicide kit. The fact that nitrites are readily available online underscores the importance of establishing effective preventive measures such as limiting the access and use of this chemical.
Identifiants
pubmed: 37526251
doi: 10.1111/1556-4029.15350
doi:
Substances chimiques
Sodium Nitrite
M0KG633D4F
Nitrites
0
Powders
0
Metoclopramide
L4YEB44I46
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
2200-2204Informations de copyright
© 2023 American Academy of Forensic Sciences.
Références
Hwang C, Yeon SH, Jung J, Na JY. An autopsy case of sodium nitrite-induced methemoglobinemia with various post-mortem analyses. Forensic Sci Med Pathol. 2021;17(3):475-480. https://doi.org/10.1007/s12024-021-00378-w
Tournoud C, Boltz P, Paradis C, Vodovar D, Puskarczyk E. Suicide by ingestion of nitrite salts: it is possible! Toxicol Anal Clin. 2021;33(3 Suppl):S23.
Durão C, Pedrosa F, Dinis-Oliveira RJ. A fatal case by a suicide kit containing sodium nitrite ordered on the internet. J Forensic Leg Med. 2020;73:101989. https://doi.org/10.1016/j.jflm.2020.101989
Chui JSW, Poon WT, Chan KC, Chan AYW, Buckley TA. Nitrite-induced methaemoglobinaemia - aetiology, diagnosis, and treatment. Anaesthesia. 2005;60(5):496-500. https://doi.org/10.1111/j.1365-2044.2004.04076.x
Durão C, Pedrosa F, Dinis-Oliveira RJ. Another suicide by sodium nitrite and multiple drugs: an alarming trend for “exit”? Forensic Sci Med Pathol. 2021;17(2):362-366. https://doi.org/10.1007/s12024-020-00340-2
Dean DE, Looman KB, Topmiller RG. Fatal methemoglobinemia in three suicidal sodium nitrite poisonings. J Forensic Sci. 2021;66(4):1570-1576. https://doi.org/10.1111/1556-4029.14689
Neth MR, Love JS, Horowitz BZ, Shertz MD, Sahni R, Daya MR. Fatal sodium nitrite poisoning: key considerations for prehospital providers. Prehosp Emerg Care. 2021;25(6):844-850. https://doi.org/10.1080/10903127.2020.1838009
Tomsia M, Głaz M, Nowicka J, Szczepański M. Sodium nitrite detection in costal cartilage and vitreous humor - case report of fatal poisoning with sodium nitrite. J Forensic Leg Med. 2021;81:102186. https://doi.org/10.1016/j.jflm.2021.102186
Barranco R, Frigiolini FME, Orcioni GF, Malandrino M, Salomone A, Ventura F. A rare case of fatal self-poisoning with sodium nitrite: autopsy and toxicological findings. Am J Forensic Med Pathol. 2021;42(4):379-382. https://doi.org/10.1097/PAF.0000000000000697
Mun SH, Park GJ, Lee JH, Kim YM, Chai HS, Kim SC. Two cases of fatal methemoglobinemia caused by self-poisoning with sodium nitrite. Medicine (Baltimore). 2022;101(7):e28810. https://doi.org/10.1097/MD.0000000000028810
Hickey TBM, MacNeil JA, Hansmeyer C, Pickup MJ. Fatal methemoglobinemia: a case series highlighting a new trend in intentional sodium nitrite or sodium nitrate ingestion as a method of suicide. Forensic Sci Int. 2021;326:110907. https://doi.org/10.1016/j.forsciint.2021.110907
Gowans WJ. Fatal methaemoglobinaemia in a dental nurse. A case of sodium nitrite poisoning. Br J Gen Pract J R Coll Gen Pract. 1990;40(340):470-471.
Baselt R, Randall C. Disposition of toxic drugs and chemicals in man. 9th ed. Seal Beach: Biomedical Publications; 2011. p. 1208-1209.
Schulz M, Iwersen-Bergmann S, Andresen H, Schmoldt A. Therapeutic and toxic blood concentrations of nearly 1,000 drugs and other xenobiotics. Crit Care. 2012;16(4):R136. https://doi.org/10.1186/cc11441
Prouty RW, Anderson WH. The forensic science implications of site and temporal influences on postmortem blood-drug concentrations. J Forensic Sci. 1990;35(2):243-270.
Han E, Kim E, Hong H, Jeong S, Kim J, In S, et al. Evaluation of postmortem redistribution phenomena for commonly encountered drugs. Forensic Sci Int. 2012;219(1-3):265-271. https://doi.org/10.1016/j.forsciint.2012.01.016
RCP Ranitidine. ANSM (French National Drug Safety Agency). 2012. http://agence-prd.ansm.sante.fr/php/ecodex/rcp/R0206194.htm. Accessed 13 Jul 2023.