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Sodium azide poisoning: a narrative review
John Tat1, Karen Heskett2, Shiho Satomi1
1Department of Medicine, University of California, San Diego, La Jolla, CA, USA.
Clinical Toxicology (Philadelphia, Pa.)
|June 15, 2021
Summary
Sodium azide poisoning cases are increasing due to its availability and use in airbags. Hydroxocobalamin shows promise as a treatment for severe azide poisoning, which can cause dangerous hypotension.
Area of Science:
- Toxicology
- Emergency Medicine
- Chemical Safety
Background:
- Sodium azide is a highly toxic chemical with increasing production and availability.
- Widespread use in vehicular airbags and online availability contribute to potential exposures.
- No specific antidote currently exists for azide poisoning.
Purpose of the Study:
- To systematically review recent human poisoning reports involving sodium azide.
- To assess exposure scenarios, clinical presentations, and treatment strategies for azide poisoning.
- To evaluate trends in azide poisoning over the last two decades.
Main Methods:
- Conducted a systematic literature review of medical and newspaper databases (2000-2020).
- Searched for terms related to sodium azide/hydrazoic acid and poisoning outcomes.
- Included peer-reviewed papers and news articles describing human azide poisoning cases.
Main Results:
- Identified 156 cases of azide poisoning, averaging 7.8 cases per year (a threefold increase from previous periods).
- Common exposure scenarios include laboratory work, secondary exposure of medical personnel, and airbag incidents.
- Profound hypotension was a common symptom, requiring aggressive hemodynamic support; hydroxocobalamin was used in some severe cases.
Conclusions:
- Increased azide poisoning reports correlate with its commercial use and availability.
- Aggressive hemodynamic support is crucial for managing systemic azide poisoning.
- Hydroxocobalamin presents a rational therapeutic option for azide poisoning based on its mechanism.
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