Received July 3, 2020 from Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon, USA (MRN, JSL, BZH, MRD); Tualatin Valley Fire & Rescue, Tigard, Oregon, USA (MRN, MRD); Oregon-Alaska Poison Center, Portland, Oregon, USA (JSL, BZH); Providence St. Vincent Medical Center, Portland, Oregon, USA (MDS); Washington County Emergency Medical Services, Hillsboro, Oregon, USA (RS). Revision received October 8, 2020; accepted for publication October 12, 2020.
Prehosp Emerg Care. 2021 Nov-Dec;25(6):844-850. doi: 10.1080/10903127.2020.1838009. Epub 2020 Nov 5.
Sodium nitrite is a powerful oxidizing agent that causes hypotension and limits oxygen transport and delivery in the body through the formation of methemoglobin. Clinical manifestations can include cyanosis, hypoxia, altered consciousness, dysrhythmias, and death. The majority of reports on sodium nitrite poisonings have been the result of unintentional exposures. We report a case of an intentional fatal overdose of sodium nitrite. A 17-year-old female reportedly drank approximately one tablespoon of sodium nitrite in a self-harm attempt. The patient was hypotensive and cyanotic upon EMS arrival. The patient decompensated rapidly into a bradycardic arrest during transport despite intubation, push-dose epinephrine, and intravenous fluid resuscitation. In the Emergency Department (ED), she received methylene blue and packed red cells but could not be resuscitated despite a prolonged effort. EMS professionals should consider sodium nitrite toxicity in patients with a suspected overdose who present with a cyanotic appearance, pulse oximetry that remains around 85% despite oxygen, and dark brown blood seen on venipuncture. Early prehospital contact with the Poison Control Center and ED prenotification in poisoned patients is encouraged.
亚硝酸钠是一种强有力的氧化剂，可导致低血压，并通过形成高铁血红蛋白限制体内的氧气运输和输送。临床表现包括发绀、缺氧、意识改变、心律失常和死亡。大多数关于亚硝酸钠中毒的报告都是意外暴露的结果。我们报告了一例故意服用亚硝酸钠过量导致的致命病例。据报道，一名 17 岁女性在试图自残时喝下了约一汤匙的亚硝酸钠。患者在 EMS 到达时出现低血压和发绀。尽管进行了气管插管、推注肾上腺素和静脉补液复苏，但在转运过程中，患者迅速出现心动过缓性心跳骤停。在急诊科，她接受了亚甲蓝和红细胞悬液，但尽管进行了长时间的努力，仍无法复苏。对于出现发绀外观、脉搏血氧饱和度尽管吸氧仍维持在 85%左右且静脉穿刺时可见深棕色血液的疑似过量服用的患者，EMS 专业人员应考虑亚硝酸钠毒性。鼓励在中毒患者中进行早期院前与中毒控制中心联系和 ED 预先通知。
