Comparing Confirmed Sodium Nitrite Suicide Deaths With Poison Center Surveillance Estimates

Area of Science:

• Forensic Toxicology
• Public Health Surveillance
• Chemical Safety

Background:

• Sodium nitrite, a common curing agent, is increasingly implicated in self-harm and suicide cases.
• Current surveillance methods in the United States may be insufficient for tracking sodium nitrite-related fatalities.
• Lack of standardized forensic investigation approaches hinders accurate case identification.

Purpose of the Study:

• To establish a standardized forensic approach for identifying sodium nitrite deaths.
• To compare forensic findings with existing poison center surveillance data.
• To assess the trend of sodium nitrite-related deaths and exposures.

Main Methods:

• Retrospective case series analysis of deaths and exposures in two New York medical examiner jurisdictions (2000-2022).
• Utilized medical examiner reports (cause of death) and poison center reports (intentional exposures).
• Established medical examiner determination via confirmatory blood nitrite testing as the criterion standard.

Main Results:

• Identified 36 decedents, with a median age of 28 years; 63.8% were male.
• Observed a significant yearly increase in sodium nitrite deaths from 2019 to 2022, largely missed by poison center surveillance.
• Confirmatory postmortem blood nitrite concentrations were obtained in 83.3% of cases; some decedents accessed suicide information online.

Conclusions:

• Sodium nitrite deaths are rising, and medical examiner data confirms this trend.
• Poison center surveillance significantly underestimates the true burden of sodium nitrite-related fatalities.
• Standardized forensic analysis and multi-source data are essential for effective public health monitoring and intervention.