Author

Brianna Peterson, PhD, F-ABFT; Ayako Chan-Hosokawa, MS, D-ABFT-FT

Impact statement

The popularity of suicide by nitrites/nitrates has increased significantly since 2018. Online suicide forums provide step-by-step instructions for how to use nitrites/nitrates for suicide and they are readily accessible to purchase. Sodium nitrate and sodium nitrite are inorganic compounds that are found endogenously in water and some foods. They are also commonly used as a preservative by food manufacturers and present in fertilizers. Nitrates/nitrites have high bioavailability (>92%) and do not undergo first-pass metabolism. Concentrations peak ~3 hours post-ingestion and can be detected ~1 hour after ingestion. 60-70% of the dose is excreted in the urine within the first 24 hours. Although not harmful at low concentrations, death can occur at higher nitrate/nitrite concentrations from acute methemoglobinemia, a condition characterized by increased levels of methemoglobin (MetHb), where the reduced ferrous (Fe+2) of hemoglobin is oxidized to the ferric (Fe+3) state, and a resultant lack of oxygen to the body. Common autopsy findings are chocolate brown blood and/or organs, cyanotic (gray) discoloration of bodies, and pulmonary or cerebral edema. There will often be an internet history of purchase or sodium nitrite bottles on scene

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