Helloooo, I'm sharing my story of ingesting SN in the hopes the information is useful to some people. I've requested copies of my medical and ambulance records which is why I'm able to be so detailed, alongside memory recall of the day and very brief notes I wrote at the time/shortly afterwards.
Context
I ordered 50g sodium nitrite via the Canadian IC source (no longer exists) and received the parcel on the same day I ingested it. I was constantly experiencing suicidal thoughts in the lead-up to this and ingested it with intent of dying. However, within minutes of taking SN I decided I guess I got cold feet and in the moment was reminded of (admittedly very few) connections to life/reasons to keep living; so left it up to fate in a way, by self-rescuing. This was about 6 months ago. I was about 95kg and 175cm.
Pre-ingestion of SN
I fasted by not eating in the afternoon/evening on that day (upwards of 10 hours fasting).
I travelled to a quiet field next to a park (there were no people around in the area I was)
I took 1500mg paracetamol 1hr before ingestion.
I took 30mg metoclopramide 45mins before ingestion.
I ingested 1/2 a tablespoon of sodium nitrite (not accurately measured, so unsure how many g this was) at 22:35.
22:35 Initial Symptoms/Impact
Slight tremor and discomfort in arms and legs, though I now know this was actually due to the metoclopramide NOT the sodium nitrite (I experienced this symptoms later, taking the same dose of metoclopramide, I do not have this symptoms when taking prochlorperazine). It was really tiring to remain standing in the minutes leading up to and after ingestion and I felt droswy. My breathing became a little bit heavier, but was not uncomfortable or painful. I was very reflective in this couple of minutes, thinking about reasons for dying and connection to life, and it was sort of like a 'quickplay' of memories and moments in my life - I put this down to researching SN and knowing how fatal the substance is.
22:47 Call to NHS 111
At this point, I 'self-rescued' by reaching out for medical help. Honestly I'm not sure why. But right now I think I'm glad I did (though I have BPD/EUPD so it fluctuates... a lot). I was allocated an emergency ambulance response for risk of suicide (category 3). A category 3 call has a target response time of 120 minutes. The call was passed from NHS 111 to 999 at 22:53. I had a pulse oximiter with me at the time, and between 22:53 and 23:03, my o2 sat reached 85%. I remember telling the NHS 111 health advisor this, and that is what triggered an upgrade to category 2 (target response time of 18 minutes). The NHS 111 team also contacted police too, to ask for them to respond too.
23:03 Crew dispatched
The ambulance crew were dispatched at 23:03 and were mobile at 23:04. The NHS 111 health advisor remained on the phone with me, however I did not say much as I began to feel nauseous and continued to feel tired standing and slightly droswy (remained GCS 15 & alert).
23:25 Ambulance arrived
Police and ambulance crew (paramedic, paramedic student and a technician) arrived at about the same time, however police were not needed as I walked to the ambulance once asked to. They found me sat on a bench. Their assessment noted that my airway was clear with equal entry, however my respiratory rate was 34/min and I appeared cyanosed (blue). It was a cold night, so I also appeared hypothermic and was shivering. I was given oxygen at a rate of 15L/min through a non-rebreather mask however this did not improve my oxygen sats much.
23:40 Vital Signs/NEWS2
Pupils equal and reactive, both 8mm
AVPU: Alert
GCS: 15
Capillary refill: 3 secs
Resp rate: 22
Pulse: 170 BPM
SpO2: 81 on room air
SpO2: 85 on oxygen
BP: 153/71
Glucose: 8.8
Temp: 35 degrees
NEW2 Score: 11
23:45 Activated Charcoal
I was given activated charcoal and had 1/2 of the bottle/dose (25g of 50g). I'm unsure if this had any effect on the poisoning, but doctors appeared pleased I was given it by the crew. At this point, in terms of symptoms, they remained the same as before, tiredness with heavy/fast breathing but no pain. I had an ECG taken and was also warmed with heated blankets. I was cannulated by the crew.
23:58 Left scene
The ambulance left scene on route to hospital.
00:02 Pre-alert to emergency department
Due to my NEWS2 score (meaning high clinical risk / emergency response threshold for assessment by a team with critical care competencies) the ambulance crew informed the hospital they were on route, providing an an ATMIST handover.
00:22 Vital Signs/NEWS2
Resp rate: 26
Pulse: 137
SpO2: 87%
BP: 121/94
Temp: 35.6 degrees
NEWS2 Score: 12
00:25 Arrived at hospital
Taken to the resus bay and seen by the team (registrar & 2 nurses) who were awaiting due to the pre-alert. Whilst in the emergency department, my SpO2 reached 63% (I'm not sure how this was so different to the ambulance SpO2 - I assume progression of the sodium nitrite absorption?). I was given oxygen through both a nasal cannula and a NBR simulatenously. The doctors discussed with Toxbase/NPIS and also made a referral to critical care who came down to the emergency department to support with treatment. The notes record that I was cold, experiencing peripheral shutdown, was shivering, sweaty, had a slate grey appearance, had profound central and periphoral cyanosis and was nauseated. Experienced palpitations.
Baseline observations in hospital:
Resp rate: 24
SpO2: 69%
Pulse: 154
BP: 147/69
Temp: 36.3 degrees
GCS: 15
Glucose: 7.6
ECG: Sinus tachycardia
NEWS2 Score: 11
00:38 Venus Blood Gas
pH: 7.38
O2Hb: 28%
MetHB: 45.8%
Lact: 2.8
00:40 Methylene blue
I was given my first dose of methylene blue at this time which was 2mg/kg. I vomited a number of times after receiving this dose. There was little to no improvement in my vitals/overall condition, and I became aware that the doctors had ordered blood to be on standby for exchange transfusion (which is another treatment method for SN overdose, by transusing blood to increase oxygen carrying capability of red blood cells). The critical care doctor put in an arterial line to monitor my blood pressure and allow for the nurses to take repeated ABGs later on.
Another methylene blue dose
I was given a second methylene blue dose again 2mg/kg (4mg/kg total). Again, vomited and was nauseous. I had blue ink all over my arm where the nurse had accidently let some leak whilst attaching it to the IV. NEWS2 score at 01:00 was 9.
01:10 Post-methelyene blue blood gas
pH: 7.34
O2Hb: 72%
MetHb: 10.8%
Lact: 2.0
It was about this point, after both doses, that I was starting to feel a little less unwell/nauseated and felt my breathing was a little better. I think the doctors/nurses began tiltrating me off of additional O2 after this, as my O2 sats improved:
O2 sats:
00:35 - 83%
00:45 - 82%
01:00 - 69%
01:15 - 77%
01:30 - 98%
02:00 Handed over to ICU
I was admitted to ICU and received 1:1 nursing care (hourly blood gasses and contiuous vitals monitoring). I felt pretty much back to normal except for heart rate spikes when I changed my posture or sat up in the bed, which caused the monitor to beep lots. NEWS2 score was 6. Otherwise, my time in the ICU was pretty much uneventful. However, my potassium levels did drop quite low so I required oral supplements followed by IV replacement of K.
14:00 Mental Health Liaison
Seen by mental health liaison who referred me to the crisis team lol.
15:00 ICU Research Nurse
Seen by one of the ICU research nurses who offered for me to take part in research about the chemical I took, have it tested, and to explore how I got the chemical. Refused consent for the study.
20:30 Stepped down to ward
Again, pretty much back to normal physically. No symptoms continued. Urine was blue/green discoloured because of the antidote.
09:30 Ward round
Told by ward consultant that sodium nitrite has a short half-life so was pretty much all out of my system now. NEWS2 score 0.
11:30 Discharged
Discharged home. Discoloured urine from antidote continued for at least another 48 hours I believe. Seen by mental health crisis team that evening.
So yeah... that's the story. I know others have reached very high MetHB levels upwards of 70%, however this absolutely highlights how fatal and effective sodium nitrite is. If I was to CTB with SN, I'd use prochlorperazine as I have a number of side effects of metoclopramide - so keep that in mind folks. Be sure you're not allergic/have lots of side effects to the antiemetics.
I'm open to questions if you have any, and sorry for failing to follow the correct procedure by self-rescuing..
Context
I ordered 50g sodium nitrite via the Canadian IC source (no longer exists) and received the parcel on the same day I ingested it. I was constantly experiencing suicidal thoughts in the lead-up to this and ingested it with intent of dying. However, within minutes of taking SN I decided I guess I got cold feet and in the moment was reminded of (admittedly very few) connections to life/reasons to keep living; so left it up to fate in a way, by self-rescuing. This was about 6 months ago. I was about 95kg and 175cm.
Pre-ingestion of SN
I fasted by not eating in the afternoon/evening on that day (upwards of 10 hours fasting).
I travelled to a quiet field next to a park (there were no people around in the area I was)
I took 1500mg paracetamol 1hr before ingestion.
I took 30mg metoclopramide 45mins before ingestion.
I ingested 1/2 a tablespoon of sodium nitrite (not accurately measured, so unsure how many g this was) at 22:35.
22:35 Initial Symptoms/Impact
Slight tremor and discomfort in arms and legs, though I now know this was actually due to the metoclopramide NOT the sodium nitrite (I experienced this symptoms later, taking the same dose of metoclopramide, I do not have this symptoms when taking prochlorperazine). It was really tiring to remain standing in the minutes leading up to and after ingestion and I felt droswy. My breathing became a little bit heavier, but was not uncomfortable or painful. I was very reflective in this couple of minutes, thinking about reasons for dying and connection to life, and it was sort of like a 'quickplay' of memories and moments in my life - I put this down to researching SN and knowing how fatal the substance is.
22:47 Call to NHS 111
At this point, I 'self-rescued' by reaching out for medical help. Honestly I'm not sure why. But right now I think I'm glad I did (though I have BPD/EUPD so it fluctuates... a lot). I was allocated an emergency ambulance response for risk of suicide (category 3). A category 3 call has a target response time of 120 minutes. The call was passed from NHS 111 to 999 at 22:53. I had a pulse oximiter with me at the time, and between 22:53 and 23:03, my o2 sat reached 85%. I remember telling the NHS 111 health advisor this, and that is what triggered an upgrade to category 2 (target response time of 18 minutes). The NHS 111 team also contacted police too, to ask for them to respond too.
23:03 Crew dispatched
The ambulance crew were dispatched at 23:03 and were mobile at 23:04. The NHS 111 health advisor remained on the phone with me, however I did not say much as I began to feel nauseous and continued to feel tired standing and slightly droswy (remained GCS 15 & alert).
23:25 Ambulance arrived
Police and ambulance crew (paramedic, paramedic student and a technician) arrived at about the same time, however police were not needed as I walked to the ambulance once asked to. They found me sat on a bench. Their assessment noted that my airway was clear with equal entry, however my respiratory rate was 34/min and I appeared cyanosed (blue). It was a cold night, so I also appeared hypothermic and was shivering. I was given oxygen at a rate of 15L/min through a non-rebreather mask however this did not improve my oxygen sats much.
23:40 Vital Signs/NEWS2
Pupils equal and reactive, both 8mm
AVPU: Alert
GCS: 15
Capillary refill: 3 secs
Resp rate: 22
Pulse: 170 BPM
SpO2: 81 on room air
SpO2: 85 on oxygen
BP: 153/71
Glucose: 8.8
Temp: 35 degrees
NEW2 Score: 11
23:45 Activated Charcoal
I was given activated charcoal and had 1/2 of the bottle/dose (25g of 50g). I'm unsure if this had any effect on the poisoning, but doctors appeared pleased I was given it by the crew. At this point, in terms of symptoms, they remained the same as before, tiredness with heavy/fast breathing but no pain. I had an ECG taken and was also warmed with heated blankets. I was cannulated by the crew.
23:58 Left scene
The ambulance left scene on route to hospital.
00:02 Pre-alert to emergency department
Due to my NEWS2 score (meaning high clinical risk / emergency response threshold for assessment by a team with critical care competencies) the ambulance crew informed the hospital they were on route, providing an an ATMIST handover.
00:22 Vital Signs/NEWS2
Resp rate: 26
Pulse: 137
SpO2: 87%
BP: 121/94
Temp: 35.6 degrees
NEWS2 Score: 12
00:25 Arrived at hospital
Taken to the resus bay and seen by the team (registrar & 2 nurses) who were awaiting due to the pre-alert. Whilst in the emergency department, my SpO2 reached 63% (I'm not sure how this was so different to the ambulance SpO2 - I assume progression of the sodium nitrite absorption?). I was given oxygen through both a nasal cannula and a NBR simulatenously. The doctors discussed with Toxbase/NPIS and also made a referral to critical care who came down to the emergency department to support with treatment. The notes record that I was cold, experiencing peripheral shutdown, was shivering, sweaty, had a slate grey appearance, had profound central and periphoral cyanosis and was nauseated. Experienced palpitations.
Baseline observations in hospital:
Resp rate: 24
SpO2: 69%
Pulse: 154
BP: 147/69
Temp: 36.3 degrees
GCS: 15
Glucose: 7.6
ECG: Sinus tachycardia
NEWS2 Score: 11
00:38 Venus Blood Gas
pH: 7.38
O2Hb: 28%
MetHB: 45.8%
Lact: 2.8
00:40 Methylene blue
I was given my first dose of methylene blue at this time which was 2mg/kg. I vomited a number of times after receiving this dose. There was little to no improvement in my vitals/overall condition, and I became aware that the doctors had ordered blood to be on standby for exchange transfusion (which is another treatment method for SN overdose, by transusing blood to increase oxygen carrying capability of red blood cells). The critical care doctor put in an arterial line to monitor my blood pressure and allow for the nurses to take repeated ABGs later on.
Another methylene blue dose
I was given a second methylene blue dose again 2mg/kg (4mg/kg total). Again, vomited and was nauseous. I had blue ink all over my arm where the nurse had accidently let some leak whilst attaching it to the IV. NEWS2 score at 01:00 was 9.
01:10 Post-methelyene blue blood gas
pH: 7.34
O2Hb: 72%
MetHb: 10.8%
Lact: 2.0
It was about this point, after both doses, that I was starting to feel a little less unwell/nauseated and felt my breathing was a little better. I think the doctors/nurses began tiltrating me off of additional O2 after this, as my O2 sats improved:
O2 sats:
00:35 - 83%
00:45 - 82%
01:00 - 69%
01:15 - 77%
01:30 - 98%
02:00 Handed over to ICU
I was admitted to ICU and received 1:1 nursing care (hourly blood gasses and contiuous vitals monitoring). I felt pretty much back to normal except for heart rate spikes when I changed my posture or sat up in the bed, which caused the monitor to beep lots. NEWS2 score was 6. Otherwise, my time in the ICU was pretty much uneventful. However, my potassium levels did drop quite low so I required oral supplements followed by IV replacement of K.
14:00 Mental Health Liaison
Seen by mental health liaison who referred me to the crisis team lol.
15:00 ICU Research Nurse
Seen by one of the ICU research nurses who offered for me to take part in research about the chemical I took, have it tested, and to explore how I got the chemical. Refused consent for the study.
20:30 Stepped down to ward
Again, pretty much back to normal physically. No symptoms continued. Urine was blue/green discoloured because of the antidote.
09:30 Ward round
Told by ward consultant that sodium nitrite has a short half-life so was pretty much all out of my system now. NEWS2 score 0.
11:30 Discharged
Discharged home. Discoloured urine from antidote continued for at least another 48 hours I believe. Seen by mental health crisis team that evening.
So yeah... that's the story. I know others have reached very high MetHB levels upwards of 70%, however this absolutely highlights how fatal and effective sodium nitrite is. If I was to CTB with SN, I'd use prochlorperazine as I have a number of side effects of metoclopramide - so keep that in mind folks. Be sure you're not allergic/have lots of side effects to the antiemetics.
I'm open to questions if you have any, and sorry for failing to follow the correct procedure by self-rescuing..
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