Kaubrytė Sofija Saulė, Chmieliauskas Sigitas, Salyklytė Giedrė, Laima Sigitas, Vasiljevaitė Diana, Stasiūnienė Jurgita, Petreikis Paulius, Badaras Robertas
Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Department of Pathology, Forensic Medicine, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Acta Med Litu. 2025;32(1):160-172. doi: 10.15388/Amed.2025.32.1.11. Epub 2025 Feb 18.
Nitrate and nitrite toxicity, particularly from sodium nitrite and sodium nitrate ingestion, has become a critical public health issue due to its role in accidental poisoning, foodborne exposure, and intentional self-harm. Sodium nitrite, commonly used in food preservation, is increasingly linked to suicide, with online resources providing accessible information on lethal dosages. This trend underscores an urgent need for regulatory action and preventive strategies. This report details a fatal case of nitrate and nitrite toxicity in a 19-year-old female, presenting a complex toxicological profile involving ethyl alcohol, amphetamines, and additional pharmaceuticals.
A systematic literature search was conducted across and databases, spanning articles published over a period of the last 10 years, utilizing keywords relevant to the topic under consideration and their combinations. 58 pertinent articles were selected, supplemented by data from the , involving a clinical case. Autopsy findings, toxicological analyses, and contextual details were meticulously examined to elucidate the mechanism and circumstances of death.
A 19-year-old female was found deceased in her home, alongside a suicide note indicating intent to self-harm through ingestion of sodium nitrate, sodium nitrite, and multiple medications. The autopsy findings included cherry-brown lividity, dark, non-coagulated blood within the heart chambers, and significant multi-organ congestion, consistent with methemoglobinemia and systemic hypoxia. Toxicology results confirmed a blood alcohol concentration of 1.22‰, with trace levels of amphetamine, atropine, and quetiapine, while nitrites detected in the gastric contents confirmed sodium nitrite as a primary toxic agent. The toxic synergy of these substances ultimately led to fatal multi-organ compromise.
This case emphasizes the serious risks associated with nitrate and nitrite ingestion, particularly in instances of intentional overdose facilitated by readily accessible online information on lethal dosages. The autopsy findings reveal characteristic signs of methemoglobinemia and systemic hypoxia; however, a thorough forensic assessment must also consider additional factors, including the presence of a suicide note, the scene context, and any substances collected at the location.
Due to the inherent instability of nitrite in blood, its post-mortem detection is often challenging, thereby complicating toxicological confirmation. The increasing accessibility and misuse of sodium nitrite underscore an urgent need for regulatory oversight, public awareness, and enhanced preventive measures to address the rising incidence of intentional sodium nitrite toxicity, particularly within at-risk populations.
硝酸盐和亚硝酸盐中毒，尤其是因摄入亚硝酸钠和硝酸钠导致的中毒，由于其在意外中毒、食源性暴露和故意自残中所起的作用，已成为一个关键的公共卫生问题。常用于食品保存的亚硝酸钠与自杀的关联日益增加，在线资源提供了关于致死剂量的可获取信息。这一趋势凸显了采取监管行动和预防策略的迫切需求。本报告详细介绍了一名19岁女性硝酸盐和亚硝酸盐中毒致死的病例，该病例呈现出涉及乙醇、苯丙胺和其他药物的复杂毒理学特征。
在多个数据库中进行了系统的文献检索，涵盖过去10年发表的文章，使用与所考虑主题相关的关键词及其组合。挑选出58篇相关文章，并辅以一个临床病例的数据。仔细检查尸检结果、毒理学分析和背景细节，以阐明死亡机制和情况。
一名19岁女性被发现死于家中，旁边有一张自杀纸条，表明其意图通过摄入硝酸钠、亚硝酸钠和多种药物进行自残。尸检结果包括樱桃棕色尸斑、心腔内深色、未凝固的血液以及明显的多器官充血，符合高铁血红蛋白血症和全身缺氧的表现。毒理学结果证实血液酒精浓度为1.22‰，含有微量苯丙胺、阿托品和喹硫平，而胃内容物中检测到的亚硝酸盐证实亚硝酸钠是主要有毒物质。这些物质的毒性协同作用最终导致致命的多器官功能损害。
该病例强调了摄入硝酸盐和亚硝酸盐相关的严重风险，特别是在有关于致死剂量的容易获取的在线信息助长故意过量摄入的情况下。尸检结果揭示了高铁血红蛋白血症和全身缺氧的特征性体征；然而，全面的法医评估还必须考虑其他因素，包括自杀纸条的存在、现场情况以及在该地点收集的任何物质。
由于亚硝酸盐在血液中固有的不稳定性，其死后检测往往具有挑战性，从而使毒理学确认变得复杂。亚硝酸钠越来越容易获取且被滥用，这凸显了迫切需要进行监管监督、提高公众意识并加强预防措施，以应对故意亚硝酸钠中毒发生率上升的问题，特别是在高危人群中。
