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ACUTE EXPOSURE INFORMATION

  1. USES: Sodium nitrite is used in combination with amyl nitrite and sodium thiosulfate as an antidote for cyanide poisoning. Industrially, sodium nitrite is used in diazotization, rubber accelerators, meat curing and preserving, multipurpose greases, and photography, and as an analytical reagent, chemical intermediate, corrosion inhibitor, and detinning agent.
  1. PHARMACOLOGY: As an antidote for cyanide poisoning, sodium nitrite reacts with hemoglobin to produce methemoglobin, which then protects cytochrome oxidase activity from cyanide ions by having cyanide bind to the methemoglobin. Cyanide will then dissociate from the methemoglobin and convert to thiocyanate, which is relatively nontoxic, and then is excreted in the urine. Sodium nitrite also acts as a vasodilator by relaxing vascular smooth muscle.
  1. TOXICOLOGY: Sodium nitrite oxidizes the iron in hemoglobin from the ferrous to the ferric state, producing methemoglobin, which cannot accept and transport oxygen, resulting in tissue hypoxia. Toxicity has occurred after injection, ingestion and dermal application.
  1. EPIDEMIOLOGY: Overdose is rare; however, there have been reports of inadvertent ingestion of sodium nitrite (mistaken for salt), resulting in severe cyanosis, methemoglobinemia, and death.
  1. WITH THERAPEUTIC USE
    1. Vasodilation, leading to hypotension, tachycardia, and syncope, methemoglobinemia, headache, dizziness, nausea, vomiting, abdominal pain, cyanosis, dyspnea, and tachypnea may occur with sodium nitrite therapy.
  1. WITH POISONING/EXPOSURE
    1. MILD TO MODERATE TOXICITY: Nausea and vomiting, hypotension, tachycardia, paresthesias, headaches, cyanosis, dyspnea, and tachypnea.
    1. SEVERE TOXICITY: Methemoglobinemia commonly occurs with sodium nitrite toxicity. Although symptoms of methemoglobinemia can occur at blood methemoglobin concentrations of 15%, typically symptoms may not appear until methemoglobin concentrations are 30% or greater, and may include cyanosis, respiratory distress, metabolic acidosis, seizures, coma, circulatory failure, and death.
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