Hamilton County Coroner's Office, Cincinnati, OH, USA.
J Forensic Sci. 2021 Jul;66(4):1570-1576. doi: 10.1111/1556-4029.14689. Epub 2021 Feb 17.
Nitrites are chemicals that are abundant in the environment, widely used as preservatives for meat, and in pharmaceuticals. Volatile products containing nitrites have been used recreationally for the euphoric effect associated with mild hypoxia. Dietary exposure to small amounts is considered harmless. Deaths by ingestion of nitrite salts are not common, but accidental exposure and as suicidal and homicidal agents have been noted. Death is a consequence of oxidation of hemoglobin ferrous (Fe ) iron (Hb) to the ferric (Fe ) form (methemoglobin, MetHb), causing a reduction in the oxygen-carrying capacity of the blood. We report three cases of ingestion of sodium nitrite in two college students (one mildly decomposed) and one adult in early middle age. All of the decedents in these cases developed fatal methemoglobinemia. Sodium nitrite in chemical form was found near the bodies. MetHb was detected in the postmortem blood of each decedent. The MetHb concentrations in the two decedents with a short postmortem interval were less than MetHb concentrations reported in the current literature. The MetHb concentrations reported in the mildly decomposed person were greater than for the other two, but still less than the concentration previously considered lethal. The data from these cases indicate that levels of MetHb can vary widely in fatal cases, and should not be used as the sole criterion for determination of a death caused by sodium nitrite. Following a discussion of the cases, there is a review of the pathophysiology of MetHb production and a current literature review.
亚硝酸盐是一种在环境中大量存在的化学物质，广泛用作肉类防腐剂和药物。含有亚硝酸盐的挥发性产品曾被娱乐性使用，以产生与轻度缺氧相关的欣快感。摄入少量亚硝酸盐被认为是无害的。摄入亚硝酸盐盐导致的死亡并不常见，但已注意到意外接触和作为自杀和他杀手段。死亡是由于血红蛋白亚铁（Fe）铁（Hb）氧化为三价铁（Fe）形式（高铁血红蛋白，MetHb），导致血液携氧能力下降的结果。我们报告了三例在两名大学生（一名轻度腐烂）和一名中年成年人中摄入亚硝酸钠的案例。这些案例中的所有死者都发生了致命的高铁血红蛋白血症。在尸体附近发现了亚硝酸钠的化学形式。在每个死者的死后血液中都检测到了 MetHb。具有短死后间隔的两名死者的 MetHb 浓度低于当前文献中报道的 MetHb 浓度。轻度腐烂者的 MetHb 浓度高于其他两人，但仍低于先前认为致命的浓度。这些案例的数据表明，在致命案例中，MetHb 水平可能差异很大，不应将其作为确定亚硝酸钠引起死亡的唯一标准。在讨论了这些案例后，我们回顾了 MetHb 产生的病理生理学，并对当前文献进行了综述。
