Management of poisoning
Bev-Lorraine True, Robert H. Dreisbach in Dreisbach’s HANDBOOK of POISONING, 2001
Methemoglobin is formed by oxidation of the ferrous (Fe2+) iron of hemoglobin to the ferric (Fe3+) form by the action of a number of chemicals. Methemoglobinemia is not capable of carrying oxygen. For example, sodium nitrite is used in meat curing; it may be present in excess in home-cured meat, or the meat-curing salt may be used accidentally as table salt. In infants or children, nitrates in well water contaminated from agricultural use of fertilizers or from bismuth subnitrate may be reduced to nitrites in the intestine and absorbed to cause methemoglobinemia. Some agents capable of causing methemoglobin: analgesics (phenazopyridine, phenacetin), anesthetics (benzocaine, lidocaine), antimalarials (choroquine, dapsone), antibiotics (primaquine, sulfonamides, trimethoprim), organic nitrates and nitrites (ammonium nitrate, amyl nitrite, sodium nitrite, nitrobenzene, nitroglycerin, nitroprussside), and others (acetanilid, aniline, dimethylaniline, nitroaniline, aminobenzene, phenols, bromate and chlorate salts.
Flushing and Blushing
Frank C. Powell, Jonathan Wilkin in Rosacea: Diagnosis and Management, 2008
Flushing after exercise can also occur with some forms of cholinergic urticaria. However, monosodium glutamate intolerance (the “Chinese restaurant syndrome”) appears not to be a true example of a flushing disorder. The propensity to flush vigorously after ingestion of alcohol is genetically determined by the deficiencies of the enzymes alcohol and aldehyde dehydrogenases. Alcohol-induced flushing appears to be more common amongst those of Chinese or Japanese (and North-American-Indian) origin, and is often provoked primarily by the alcohol. The flushing can reportedly be enhanced by chemical ingredients found in certain types or even brands of alcohol (gin, vodka, or lager are often blamed). Sodium nitrite, which is found in cured meats (frankfurters, bacon, salami, ham), may cause headache and flushing in some individuals.
Potential of Fenugreek in Management of Kidney and Lung Disorders
Dilip Ghosh, Prasad Thakurdesai in Fenugreek, 2022
Renal toxicity can be associated with exposure to many chemicals or pesticides (Scammell et al. 2019; Valcke et al. 2017). Aluminum is one of the metals widely distributed in the environment and routinely used in daily life. It is also utilized for the purification of drinking water. However, an overdose of aluminum may lead to the generation of reactive oxygen species (ROS) and elevated oxidative stress, damaging renal tubular cells (Al Dera 2016). Similarly, sodium nitrite, widely used as a food preservative, is reported to induce oxidative stress, which causes DNA damage in kidney tissue (Uslu, Uslu, and Adalı 2019). Additionally, chronic exposure to various pesticides such as cypermethrin, paraquat dichloride, and captan are also documented to induce nephrotoxicity via elevated ROS in renal tissue (Sushma and Devasena 2010).
Gastroprotective effect of leaf extract of two varieties grapevine (Vitis vinifera L.) native wild and cultivar grown in North of Tunisia against the oxidative stress induced by ethanol in rats
Published in Biomarkers, 2020
Nabil Saadaoui, Asma Weslati, Taha Barkaoui, Ikram Khemiri, Wafa Gadacha, Abdelaziz Souli, Moncef Mokni, Mounira Harbi, Mossadok Ben-Attia
Total flavonoid compounds (TFC) were dosed by a colorimetric assay as described by (Chen and Chen 2011, Becker et al.2016) with minor modifications. 250 μL of sample was added to 75 μL sodium nitrite (NaNO2, 5%). After 6 min, 150 μL aluminium chloride (AlCl3 6H2O, 10%) was added. And then, after 5 min, 500 μL of sodium hydroxide (NaOH, 1 M) was added to the mixture. At this time the mixture was adjusted to 2.5 mL of distilled water, then the vortexed samples were kept at room temperature. The absorbance was directly determined at 510 nm. A calibration curve, prepared with a diluted solution of catechin and TFC were expressed as mg of catechin equivalent per g of dry matter (mg CE/g DM). As for TPC, absorbance measurements were performed with the BioRad SmartSpec™ 3000 Scan UV-visible spectrophotometer.
Rising incidence and high mortality in intentional sodium nitrite exposures reported to US poison centers
Published in Clinical Toxicology, 2021
Sean D. McCann, Marit S. Tweet, Michael S. Wahl
This retrospective study of sodium nitrite exposures identified a high mortality rate among patients reported to the NPDS. The 2019 Annual Report of the NPDS summarizes all exposures reported to NPDS by US poison centers in that year and indicated a mortality rate of 0.12% for all reported exposures, and of 0.44% for all reported intentional exposures [10]. The report includes 280,823 intentional exposures with suicidal intent, out of which 909 deaths were reported, representing a fatality rate of 0.32% in this subset. The observed mortality rate of 30% among intentional sodium nitrite exposures of suicidal intent in this study demonstrates the marked potential for fatal outcomes from this poisoning. The high water solubility of sodium nitrite, leading to rapid onset of clinical effect likely contributes to this high rate of mortality. Mudan et al. [7] describe a series of five cases of intentional ingestion of sodium nitrite which illustrates this rapid onset of clinical effects. Three of the patients in their series called emergency medical services themselves following ingestion but became unresponsive prior to emergency department arrival and suffered cardiac arrest en-route to the hospital or shortly after arrival. Sodium nitrite is sold online for the purpose of meat curing, is inexpensive and can be readily purchased in large amounts of highly pure salt granules, likely increasing the risk that patients will ingest a potentially fatal dose.
Comment on “Rising incidence and high mortality in intentional sodium nitrite exposures reported to US poison centers”
Published in Clinical Toxicology, 2022
Anita Mudan, Jacob A. Lebin, Craig G. Smollin
After noticing a cluster of severe sodium nitrite ingestions within the California Poison Control System (CPCS) in late 2019, we performed a five-year retrospective review of the CPCS database and found no reported cases prior to 2019 [2]. Similar to the present study by McCann et al., we performed an almost identical retrospective review of intentional sodium nitrite ingestions over an 11-year period (2009–2019) utilizing the NPDS database. While our initial search and inclusion criteria were similar, we reviewed full case notes for the final cohort from individual poison control centers in order to confirm the accuracy of the coded NPDS data. Our initial database query identified 42 cases of which we were able to review the full free text case notes in 35 cases. Notably, we had to exclude 18 cases, representing over half of the cohort, as the free text either documented an excluded nitrite or nitrate product or confirmed that the ingestion was not intentional.
Related Knowledge Centers
- Amine
- Azo Dye
- Corrosion Inhibitor
- Inorganic Compound
- Nitrite
- Processed Meat
- Chemical Formula
- Diazo
- Nitroso
- Curing