O2067: Emerging Trend of Sodium Nitrite and Nitrate Self-Poisoning: Fatality Review Challenges and Public Health Implications

Background: Sodium nitrite (NaNO2) and sodium nitrate (NaNO3) ingestion is an emerging method of suicide, especially among young individuals. Both substances cause methemoglobinemia (MetHb), leading to severe hypoxia and death. The rising number of deaths linked to sodium nitrite/nitrate self-poisoning, particularly among adolescents, has raised concern [1]. A study using data from the National Violent Death Reporting System (2018–2020) identified 260 suicides across 37 states and one territory due to sodium nitrite/nitrate ingestion. Victims were typically white males with a history of depression and suicidal ideation [1]. However, forensic investigations remain inconsistent, and current surveillance methods may underreport such incidents [2, 3].

Methods: Data from the Pediatric National Fatality Review-Case Reporting System (NFR-CRS) was analyzed for pediatric suicides between 2018 and 2023. Two groups were examined: one consisting of 34 children aged 14-21 who died by sodium nitrate (SN) poisoning or another salt-based chemical, and a comparison group of 4,544 children who died by suicide without mention of sodium nitrate.

Results: The mean age was similar for both groups (16.7 years for SN, 16.0 years for non-SN). In the SN group, 38% were aged 14-16, compared to 64% in the non-SN group. White children made up 62% of the SN group and 73% of the non-SN group, with the next highest proportion being Asian (24%) in the SN group and Black (12%) in the non-SN group. Males represented 71% of the SN group and 73% of the non-SN group. Children who died by SN poisoning were more likely to have seen a healthcare provider within a month before death (13% SN vs. 8% non-SN), had a mental health emergency department visit in the year prior (13% SN vs. 9% non-SN), and had been hospitalized for mental health issues (20% SN vs. 9% non-SN). However, children who died by SN suicide were less likely to have received mental health services (21% SN vs. 26% non-SN), had a history of substance use (6% SN vs. 22% non-SN), or experienced maltreatment (6% SN vs. 21% non-SN).

Conclusion: Addressing sodium nitrite/self-poisoning should be part of a broader public health approach to suicide prevention. Collaborations with healthcare providers, emergency responders, and crisis response teams can help spread awareness. Further studies are needed to evaluate the impact of safety interventions on the incidence of sodium nitrite self-poisoning.