Curing Salt in lieu of SN: You don't need gastric lavage if you're going to do it yourself - A Study

[Dying science gal]

Curing Salt in lieu of SN: You don't need gastric lavage if you're going to do it yourself
Dying Science Gal, 2024​

Abstract

Aim:
I report a self-harm incident involving one patient (myself) who experimented with the direct consumption of curing salt, a substance which contains a chemical known as sodium nitrite, in a mixture of 6.25% sodium nitrite and 93.75% sodium chloride.

The patient claimed that the incident was caused by attempting to purge using salt, but accidentally used curing salt instead. Massive vomiting and dry heaving was present during the monitoring period. Patient reports that it was "not pleasant at all".

Diagnosis:
Methemoglobinemia was initially diagnosed based on patient history and bloodwork.

Interventions:
The patient received supplemental oxygen and monitoring for six hours and was discharged home without the need of methylene blue therapy.

Lessons:
Practitioners are warned to inform patients that the direct consumption of curing salt will not work for self-harm or suicides, nor will it be pleasant.

Introduction
Sodium Nitrite is a chemical that is commonly found in curing salt, which is used for the curing of meat. Another use is as an industrial chemical and therapeutic antidote agent for cyanide intoxication. An overdose of sodium nitrite can lead to life-threatening health effects including methemoglobinemia, which can be treated using 1mg/kg of methylene blue, delivered intravenously. Sodium nitrite primarily causes toxicity by converting the ferrous iron (Fe2+) in hemoglobin into methemoglobin (MetHb), which contains ferric iron (Fe3+).

Case Description
A healthy, non-binary individual was admitted to the emergency department after an incident which involved the consumption of 1 gram of sodium nitrite, as a part of 16 grams of curing salt. The patient's chief complaints were severe nausea, headache, lightheadedness, and breathing difficulties.

Upon admission, their vital signs indicated severe tachycardia (150). The blood work is pending and therefore not available for release at this point in time. This study will be updated to include the bloodwork once it is available for release.

The patient was treated with continuous oxygen via a cannula and was observed for six hours. Methylene blue was not administered as severe nausea and associated vomiting was present, leading to a lower dose absorbed than consumed. Dry heaving was observed post vomiting, indicating the lack of gastric contents.

After the observation period, the patient was discharged with psychiatric followup without complications.

Discussion
Note: The discussion of whether if sodium nitrite should be restricted, and whether if individuals have the right to a fast and peaceful exit is out of scope for this article.

Curing salts, while useful in curing meats, has a high potential to cause significantly unwanted symptoms on consumption, including severe vomiting, nausea, headaches, lightheadedness, breathing difficulties, and methemoglobinemia.

Interventions focused on supportive care and symptom management were sufficient in this case. The decision not to administer methylene blue was guided by the patient's continuous vomiting, which reduced the effective dosage of sodium nitrite absorbed. The monitoring period allowed for stabilization and ensured no further intervention was necessary, given that the patient did not exhibit severe or persistent symptoms of methemoglobinemia.

Practitioners are warned to inform patients that the direct consumption of curing salt will not lead to successful suicides, and informs the public that the need for curing salts to be restricted is not necessary.

Conclusion
This case highlights the severe health risks associated with the ingestion of curing salt due to its sodium nitrite content. Effective management involves a combination of supportive care, continuous monitoring, and psychiatric follow-up. Increasing awareness and education about the dangers of misuse of such substances are vital in preventing similar incidents in the future.