Suicide by sodium nitrite: Autopsy case report

Introduction: Suicide by sodium nitrite poisoning (SNP) is not common. In the last decade, an increase in the number of suicides caused by SNP was observed. Case report: A 47-year-old female was found dead in her apartment. Four cups with a yellowish liquid and a scale for precise measurement were found at the scene. Also, an empty plastic bag labeled " Sodium Nitrite NaNO2". In the external examination, general signs of asphyxia were noticed. Bluish and slightly brownish hypostasis, which was prominent on the face and thighs, was present. The blood and all tissues were somewhat darker in appearance than usual. Toxicological analysis showed high levels of nitrites, nitrates, methemoglobin, and metoclopramide in blood and stomach content. It was concluded that this was a suicide by SNP. Discussion: Autopsy signs of SNP are nonspecific. The grayish-brown color of the hypostasis is a characteristic sign of SNP but is very subjective and may be missed. Sodium nitrite cannot be legally purchased for domestic use in Serbia. Even though sodium nitrite commerce is strictly regulated, the victim was able to illegally obtain it and use it in combination with the antiemetic drug metoclopramide, which shows the knowledge that exceeds the common knowledge regarding this substance and is an example of suicide committed by intellectuals. Conclusion: Cases of the fatal SNP may present a significant challenge in forensic practice due to their rarity and nonspecific presentation. Without any information about the circumstances of the case, it is often unrecognizable.