Cvetković Danica, Živković Vladimir, Lukić Vera, Nikolić Slobodan
Institute of Forensic Medicine, University of Belgrade - School of Medicine, 31a Deligradska str, Belgrade, 11000, Serbia.
Forensic Sci Med Pathol. 2019 Mar;15(1):102-105. doi: 10.1007/s12024-018-0036-1. Epub 2018 Oct 6.
Sodium nitrite is used as a coloring agent or preservative in food, as well as an antimicrobial agent in meat and fish and some cheeses. In high amounts it can be toxic for humans, causing methemoglobinemia. This is an unusual and potentially fatal condition in which hemoglobin is oxidized to methemoglobin (MHb), reducing the amount of oxygen that is released from hemoglobin, similar to carbon monoxide poisoning. MHb levels of 70% are generally lethal, but the existence of underlying anemia, acidosis, respiratory compromise, and cardiac disease may exacerbate the toxicity of MHb. We present a case of poisoning with sodium nitrite in three family members after eating homemade sausages given to them by their neighbor who was a butcher. According to the findings of the veterinary inspectorate in charge of food control in this case, the concentration of sodium nitrite in the homemade sausages was about 3.5 g per 1 kg of meat, almost 30 times higher than allowed according to legislation. In this case report, a 70-year-old man died about 7 h after consuming the meal, while two women, 53 and 67 years of age, respectively, were admitted to a toxicology clinic the following day due to food poisoning, with the maximum concentration of MHb in blood of 33.7 and 20.4%, respectively. They were discharged 3 days later. The autopsy of the deceased man showed sodium nitrite poisoning with a relatively low concentration of MHb in his blood - 9.87%. Death was attributed to the exacerbation of hypertensive and ischemic heart disease, resulting from accidental sodium nitrite poisoning. The presented cases illustrate the necessity of close cooperation between the authorities, medical staff, veterinary inspectorate, and forensic pathologists in determining the source of poisoning, the cause of death of the victim, and preventing the outbreak of poisoning among a greater number of consumers.
亚硝酸钠在食品中用作着色剂或防腐剂，在肉类、鱼类和一些奶酪中用作抗菌剂。大量摄入时对人体有毒，可导致高铁血红蛋白血症。这是一种不常见且可能致命的病症，其中血红蛋白被氧化为高铁血红蛋白（MHb），减少了从血红蛋白释放的氧气量，类似于一氧化碳中毒。高铁血红蛋白水平达到70%通常是致命的，但潜在的贫血、酸中毒、呼吸功能不全和心脏病的存在可能会加重高铁血红蛋白的毒性。我们报告了一起事件，三名家庭成员在食用了邻居（一名屠夫）送给他们的自制香肠后发生了亚硝酸钠中毒。根据负责此案食品监管的兽医检查机构的调查结果，自制香肠中亚硝酸钠的浓度约为每1千克肉3.5克，几乎是法律允许含量的30倍。在本病例报告中，一名70岁男子在进食该餐食约7小时后死亡，而两名分别为53岁和67岁的女性第二天因食物中毒被送往毒理学诊所，血液中高铁血红蛋白的最高浓度分别为33.7%和20.4%。她们在3天后出院。死者的尸检显示为亚硝酸钠中毒，其血液中高铁血红蛋白浓度相对较低——为9.87%。死亡归因于意外亚硝酸钠中毒导致的高血压和缺血性心脏病加重。所呈现的病例表明，当局、医务人员、兽医检查机构和法医病理学家之间密切合作对于确定中毒源头、受害者死因以及防止更多消费者发生中毒事件的必要性。
