Introduction
Materials and methods
Results
Rate of sodium nitrite suicides
Demographics
Medical history
Case no. | Age | Sex | History | Death scene | Autopsy | Toxicology* | External laboratory (SA pathology) |
---|---|---|---|---|---|---|---|
1 | 74 | M | • Hx: Emphysema, depression • Previous suicide attempt using sodium nitrite | • Empty bottle of sodium nitrite • Contacted ex-carer and neighbor to inform them of his intentions and say “goodbye” | • White, granular material in stomach contents • Blue-gray hypostasis • Brown discoloration of blood • Pulmonary edema | • Diazepam (0.02) • Nordiazepam (0.05) • Venlafaxine (0.75) • Desvenlafaxine (0.97) • Amlodipine (0.06) • Paracetamol (16) • Prochlorperazine (present) | • Sample was unsuitable for analysis |
2 | 60 | M | • Hx: Chronic neck pain and depression (10 years) | • A suicide note • 3 cans of Coca-Cola • Box of bicarbonate soda • 150 mL of clear liquid in a plastic jug • Piece of paper reading “10 g – 5 mL water” and “5 g sodium bicarb in water” • Empty packaging for “Back to Basics” homebrew supplies-brand sodium nitrite food grade (100 g) | • Blue-gray hypostasis • Brown discoloration of blood • Pulmonary edema | • Venlafaxine (0.9) • Desvenlafaxine (1.5) • Paracetamol (12) • Buprenorphine (0.6ug/L) • Metformin (0.63) • Mirtazapine (0.13) • COHb (31%) | • MetHb (87.5%) • COHb (negative) |
3 | 74 | M | • Resident at care facility • Hx: anxiety, chronic pain, depression, hypertension, lung carcinoma, neuropathic pain, osteoarthritis, previous prostate carcinoma… • Expressed desire to be in palliative care, previous reference to sodium nitrite as choice of method of suicide | • Suicide letters • Envelope containing an unsealed snap-lock bag labeled “sodium nitrite – food grade” from ‘back 2 basics artisan supplies’ | • Blue-gray hypostasis • Pulmonary edema • Urine dipstick positive for nitrite • No evidence of ketosis or pathologically significant alteration of renal function | • Lorazepam (0.022) • Fentanyl (2ug/L) • Metoclopramide (0.14) • Pregabalin (4.0) • COHb (51%) | • Result was outside analytical limitsa |
4 | 69 | M | • Relationship problems with wife • Hx: depression, haemochromatosis, hypertension, multiple myeloma, carpal tunnel syndrome… | • Empty bottle of wine • Small glass jar with two lines drawn in pen • Suicide note | • Blue-gray hypostasis • Brown discoloration of blood • Urine dipstick positive for nitrite • Pulmonary congestion | • Sertraline (0.32) • COHb (24%) | • Failed to give a valid result for methemoglobin due to specimen integrity |
5 | 29 | F | • Hx: depression, panic attacks, suicidal ideation • Previous suicide attempts and a hospital admission following overdose | • Called an ambulance after she had taken a mouthful of “sodium nitrate” • Farewell messages on phone • A Last Will and Testament document and a suicide note in an envelope • Container with an orange label “Sodium Nitrite” 50 g sourced from the Melbourne Food Ingredient Depot” with only a small amount remaining • A glass tumbler with white powder and liquid residue | • Blue-gray hypostasis • Brown discoloration of blood • Pulmonary edema and congestion • Urine dipstick positive for nitrite | • Naloxone (present) • COHb (25%) | • The sample failed to give a valid result on the analyzer |
6 | 64 | M | • Hx: previous colon cancer, diverticular disease, chronic back and leg pain, gastric reflux | • 2 × white powder (sodium nitrite, sodium bicarbonate) • Clear, colorless liquid (unknown) • Pale, yellow powder (sodium nitrite) | • Blue-gray hypostasis • Brown discoloration of blood • Pulmonary edema • Terminal aspiration of crystalline birefringent/refractile material • Urine dipstick positive for nitrite | • Paracetamol (24) • Codeine (0.08) • Prochlorperazine (present) • Ranitidine (present) • Loperamide (present) • COHb (34%) | • Methemoglobin analysis available was unable to produce a methemoglobin result |
7 | 23 | F | • Hx: bipolar disorder, possible borderline personality disorder, suicidal ideation | • Open bottle of sodium nitrite • Two drinking glasses, one half-full containing a yellow transparent substance and powder residue at the bottom • Suicide note • Mobile search history to “sanctionedsuicides.com” regarding methods of suicide including references to sodium nitrite | • Blue-gray hypostasis • Brown discoloration of blood • Moderate pulmonary edema and congestion • Urine dipstick positive for nitrite | • Metoclopramide (0.83) • Quetiapine (1.6) • Paracetamol (100) • COHb (51%) | • Due to sample clotting, unable to process for methemoglobin testing |
8 | 64 | M | • Hx: Type 2 diabetes mellitus, hypercholesterolemia, depression • Granted home detention bail | • Suicide notes • A glass with white residue • Plastic bag containing sodium nitrite located in desk drawer • Cylinders of nitrogen gas found under desk and in vehicle | • Early putrefactive changes • Blue-gray hypostasis • Brown discoloration of blood • Pulmonary edema and congestion • Urine dipstick positive for nitrite | • Alcohol (0.038%) • Metoclopramide (0.21) • Paracetamol (32) • Zolpidem (present) • COHb (40%) | • Sample received clotted and unable to be analyzed for methemoglobin |
9 | 22 | M | • Hx: unknown | • Clear substance in bottle next to deceased • Suicide-type note, papers and receipts | • Blue-gray hypostasis • Brown discoloration of blood • Urine dipstick positive for nitrite | • Metoclopramide (0.2) • Ranitidine (present) • Paracetamol (19) • COHb (24%) | • Instrument was unable to process the sample due to viscosity |
10 | 40 | M | • Hx: unknown | • Sodium nitrite suicide kit • Suicide note | • Advanced putrefactive change • Urine dipstick positive for nitrite | • Alcohol (0.073%)b • Paracetamol (33)b • Metoclopramide (0.62)b • Paracetamol (90 mg/kg)c • Metoclopramide (2 mg/kg)c | N/A |