Rising trends in sodium nitrite suicides: A case series from Cape Town, South Africa

Sodium nitrite (NaNO2) ingestion results in methaemoglobinaemia, which can cause hypoxia, metabolic acidosis and death. Sodium nitrite is an inorganic salt, easily accessible and widely used as a colourant, food preservative and corrosion inhibitor. Although previously rarely seen in medicolegal practice, sodium nitrite poisoning cases are increasing globally. This case series examines three fatalities investigated at the Observatory Forensic Pathology Institute (formerly Salt River Mortuary) in Cape Town, Western Cape Province, South Africa, between 2020 and 2023. The three cases involve sodium nitrite, with labelled containers found at the death scene. Postmortem findings included chocolate-brown discolouration of the blood, blue-grey discolouration of the nail beds and distinctive skin lividity. Toxicological analyses included ethanol, common drugs of abuse, methaemoglobin and sodium nitrite determined in various matrices. This report highlights the importance of thorough death scene investigations and challenges in ancillary testing, and contributes to the literature on sodium nitrite-related suicides. The accessibility and rapid lethality of the chemical underscore the need for greater awareness among medical professionals and policy-makers regarding its misuse.