yaulkan
Member
- Jun 17, 2022
- 70
Sodium nitrite is a substance commonly added to ham and sausage. Although it was not uncommon to be used for suicide in the first place, it was rare, but in 2008, a method was discovered in Australia using sodium nitrite as a poison to control the population of wild boar, an ecosystem-disrupting species, and research on it has progressed through the 2010s. The number of suicides using sodium nitrite is rapidly increasing as a detailed explanation was introduced in The Peaceful Pill Handbook, a famous suicide note written by an Australian doctor around 2017. Although sodium nitrite is a dangerous substance that can cause death with a very high probability if consumed in sufficient amount, in Korea, a lethal amount of sodium nitrite can be purchased for only a few thousand won through internet shopping, so it is urgent to prepare countermeasures.
Legally, sodium nitrite is a toxic substance according to the Chemicals Control Act. It is legally treated the same as 'cyanide', which was commonly used for suicide in the past, and 'caustic kary' and 'caustic soda' used by housewives to make natural soap at home. . According to the Chemicals Control Act, hazardous chemicals include toxic substances, permitted substances, restricted substances, prohibited substances, and accident preparation substances. Toxic substances are legally available for offline sales to the general public as well as internet shopping sales for the general public (Article 28-2 of the Act). In some cases, the duty to report to the Minister of Environment is imposed only (Article 20(3) of the Act, Article 10(2) of the Decree). Therefore, under the current law, it is impossible to punish those who purchase sodium nitrite for suicide purposes, and it is also impossible to ban the online sale of sodium nitrite on the grounds that it can be misused for suicide purposes. It is thought that it would be preferable to induce self-regulation in the industry rather than a legal approach.
Sodium nitrite and sodium nitrate have similar names but are different substances. It is known to be much less toxic than sodium nitrite. Although in one case, a 23-year-old woman ate an unacceptable amount of sodium nitrate and her methemoglobin concentration rose to 92.7% (Dela Cruz et al., 2018), a 67-year-old man ate 75 g of sodium nitrate and developed vomiting and diarrhea. There was also a case in which nothing happened, and the methemoglobin concentration measured after 4 hours was only 1.8% (Joosen et al., 2014). Successful suicide attempts with sodium nitrate are rare.
lethal dose
The Peaceful Pill Handbook (hereinafter referred to as PPH), the book that led to the first popularization of sodium nitrite suicide method, suggests 20g as the recommended intake (?). Since it is a book that claims to be a suicide note, it can be assumed that the recommended intake is the amount that achieves a 100% success rate, but in fact, that is not certain.
Many suicide manuals, including PPH, have a habit of initially setting the recommended intake of poisons quite conservatively, and then gradually increasing the recommended intake by pretending not to win when the number of people who failed to commit suicide by eating that amount accumulates. Pentobarbital is a drug that has been adopted as an oral euthanasia drug along with secobarbital according to the official guidelines* of the Dutch Medical Association and Pharmacists Association. Secobarbital and pentobarbital were mainly used until the mid-2010s when there was a supply shortage. It is worthy of being called the "gold standard" for suicidal poisons, such as using only barbital. When pentobarbital suicide was introduced in the first edition of Final Exit, the world's most recognizable suicide manual, the Netherlands had already used 9 g since then, but the book suggested 3 g as a lethal dose (Humphry, 1991). In the second edition (1996), it was quietly increased to 6g. In the third edition (2002), it was quietly increased to 9g. The Dutch Medical Association and Pharmacists Association increased the recommended intake of secobarbital and pentobarbital to 15g in 2012. Meanwhile, since the publication of the first edition in 2006, PPH introduced a suicide method using amitriptyline, a tricyclic antidepressant, and suggested 5 g as the recommended intake. Then, in 2017, an elderly woman who was active in Peaceful Pill Forums, a suicide community run by Exit International, a suicide group that publishes PPH, predicted suicide using amitriptyline 5g, and reported that it failed a few days later. Many people were shocked when they committed suicide by jumping from a high-rise building. In the next revision, the recommended intake of amitriptyline was quietly increased to 8g.
A similar thing happened with sodium nitrite. Around the end of 2017, when sodium nitrite suicide was first introduced to PPH, the PPH contained a saying that "only 2.6 g of sodium nitrite is enough for an adult." The decimal point is sufficient to give the impression that the number was scientifically accurately calculated, but in reality it was not. The lethal dose of sodium nitrite of 2.6 g for adults is found on page 1 of a Google search for 'sodium nitrite lethal dose', as reported by Katabami et al. (2016) and Chui et al. (2005) is a number that appears in the paper. Chui et al. (2005) as a basis for that number, Bradberry et al. (1994), this paper, citing the case report of Gowans (1990), says that even 1 g of sodium nitrite may cause death, but the number 2.6 g does not appear at all. After all, 2.6g is a number that has fallen from the air without any scientific basis.
It is a very dangerous attitude to accept this as scientific truth simply because it is a number published in the prestigious Hindu journal, which appears on the first page of a Google search, without such an accurate basis. For decades, it was known that the lethal dose of nicotine for adults was 60 mg. All authoritative medical papers, toxicology textbooks, US government publications, and MSDSs all stated that the lethal dose of nicotine was 60 mg. However, there is no scientific or evidence for this, and it has been recently found that the actual lethal dose is 6.5 to 13 mg/kg or more (Mayer, 2014). This kind of disaster occurs when people repeatedly quote each other based on the authority of the medical literature without properly examining the exact scientific basis for which the numbers were derived.
Maybe that's why PPH changed the lethal dose from 2.6g to 3g at the end of 2017. Perhaps it was not intended to hide the exact source of the lethality number from which paper. After 2018, the recommended intake gradually increased to 5g, 10g, and 15g whenever the monthly revision was repeated, and finally, in early 2019, it increased to 20g. The fact that there was an increase was never announced, and the reason for the increase was never given. The recommended intake for suicide statements is always quietly increased.
If so, what is the lethal dose with scientific evidence? In order to find out, it seems to be necessary to look at ① the successful and unsuccessful cases of sodium nitrite suicide and ② the results of animal experiments on pigs.
Let's look at an example of a suicide attempt with sodium nitrite in real life. First, it is an example from The Peaceful Pill Handbook. In 2018, an adult weighing 46 kg took 15 g of sodium nitrite in 50 mL of water, and became sleepy at 3 minutes, very sleepy at 5 minutes, but still responsive, unconscious at 12 minutes, and unresponsive to stimulation at 15 minutes Cyanosis developed at 25 minutes, shallow breathing, and death at 42 minutes.
The following are examples found in the paper.
A 29-year-old man ate 20-22 g of sodium nitrite and called 911 by himself 5 minutes later. The blood methemoglobin concentration measured at the hospital was 91%. After treatment with methylene blue, etc., he was transferred to a psychiatric ward without any sequelae (Bruccoleri et al., 2016).
A 28-year-old man was taken to the hospital 1 hour after consuming 15 g of sodium nitrite. He was unconscious with GCS 3, and severe cyanosis was observed on the face, lips, and toes, and the blood methemoglobin concentration was 92.5%. He was treated with methylene blue et al and was discharged without sequelae (Katabami et al., 2016).
There was a case of a 76-year-old man who had cardiac arrest 25 minutes after ingesting an unacceptable amount of sodium nitrite (Harvey et al., 2010).
Here are some examples I found on the internet.
21b8fe (weight 80 kg) ate ondansetron on June 17, 2018 to prevent vomiting, and ate 17 g of sodium nitrite mixed with 100 mL of water. After a minute or so, he felt a little sleepy, his toes slightly numb, and his face tightened. He left his last word 4 minutes after eating, and there has been no activity since.
Querry1, a 20-year-old Polish weighing 67 kg, ate 1 g of acetaminophen and drank 15 g of sodium nitrite in 60 mL of water while fasting for 6 hours around July, 2018. She didn't taste good, but it didn't taste that bad either. After 20 minutes, I got nauseous and vomited for a long time in the bathroom. Ten minutes after that, she went to her sister and told her to call 911 because of the unbearable pain (which she said felt similar to the emotional pain of depression). After an hour or so she lost consciousness. 11 hours later, she woke up in the hospital in good condition.
Axorz took metoclopramide, 10 short-acting benzodiazepines, and cimetidine, and 17 g of sodium nitrite while starving for 8 hours on September 24, 2018. He started vomiting as soon as he ate, and he thought something was going wrong, so he went to his family at home. And he lost consciousness as soon as he vomited a second time. The family called an ambulance and woke up in the intensive care unit, intubated into the airway.
Between late 2018 and early 2019, ultraviolet sin took alprazolam, metoclopramide, and 20 g of sodium nitrite in water and ate it in small portions over an hour. There was no vomiting and no pain. I felt drowsy (note: probably due to alprazolam) and numbness in the extremities of my body, but it didn't feel unnatural. It was found and rescued by the police. He had a numb feeling in his shoulder for several weeks, but it went away after that, and other than that, there were no sequelae.
Jen0804 ate cimetidine in an empty stomach on an empty stomach around February 2, 2019 and drank 12 g of sodium nitrite slowly over 15 minutes. Her feeling dizzy and drunk was getting worse and worse to the point where she couldn't even cross her crosswalk. She was found by the police while sitting in front of the church, and was taken to the hospital 20 minutes after ingestion. As her consciousness shifted back and forth, she felt a stabbing pain in her left abdomen, as well as pain in her heart and chest. She was treated and recovered.
Latergator was a 28-year-old male weighing 68 kg and ate 15 g of sodium nitrite in 100 mL of DMSO on February 25, 2019. The taste was disgusting, and I felt a slight burning sensation in my chest. (The burning sensation in the chest area was probably due to the DMSO going down and stimulating the esophagus.) Two minutes later, he said he was lying down in fear. Since then he has not been active.
On March 2, 2019, nintendominos said that they would take metoclopramide and ranitidine, and then sodium nitrite after 30 minutes. No activity since then.
Mich517 ate 20g of sodium nitrite in 100mL of DMSO without taking antiemetics on March 2, 2019, and vomited a significant amount due to vomiting. My vision was blurred, my ears were ringing, I felt like I was about to pass out, I had some convulsions, I felt numb somewhere, my heart rate was fast, my breathing was deep. After that, for some reason, I couldn't hit the keyboard properly. I went to the bathroom with a loss of consciousness and vomited a lot, then fell asleep and woke up. There was no pain at all, and the convulsions did not feel painful at all.
DyingToCTB was administered on March 5, 2019 by taking an antiemetic and cimetidine and adding 20 g of sodium nitrite to 100 mL of water. It was so salty that I had the urge to spit it out, but I resisted it. No activity since then.
Kukubananas, a female weighing 68 kg, took cimetidine, dimenhydrinate, meclizine and 15 g sodium nitrite on an empty stomach on March 11, 2019. She hasn't been active since then.
On April 11, 2019, elfonashelf took metoclopramide 30mg, cimetidine 800mg, and sodium nitrite 15g in 12 OOO size gelatin capsules. Thirty minutes later, she posted a plain, meaningless comment, and there has been no activity since.
TheRiverStyz took 15g of sodium nitrite with temazepam on April 23, 2019. No activity after that.
drakewantstogo took metoclopramide 30mg, ranitidine 225mg and sodium nitrite 17g after fasting for more than 8 hours on April 29, 2019. It tasted like salt sprinkled on car tires. After 5 minutes, severe nausea and a lot of saliva came out. After that, I vomited 3 times. Fifteen minutes later, she should have already lost consciousness, but she wasn't even sleepy, so she thought something was wrong, and she became very uncomfortable and called 911. She was hospitalized and recovered.
Batstern is a 19-year-old male weighing 63 kg, taking 10 mg of metoclopramide every 8 hours for 48 hours before and around May 2019, fasting for 6 hours before running, and then taking the last 10 mg of metoclopramide 1 hour before running. I was planning to take 20g of sodium nitrite after taking 225mg of ranitidine and 225mg of ranitidine, but I was afraid of sodium nitrite and gave up.
Kaluk drank beer after 13 hours of fasting around May 2019, sat on a chair and drank 20 g of sodium nitrite in 100 mL of water. He had a strong salty taste, but was able to swallow it to the end. He felt some nausea and dizziness, but other than that there was no discomfort. After that, he fell unconscious and fell to the front of the chair, pressing the remote control, which made the audio too loud. The police came to the rescue after a complaint from a neighbor who felt dissatisfied with the incident. It was about an hour after he took the medicine. He woke up the next day from the hospital and was forced into a psychiatric ward for two weeks.
Escaper Boy (weight 50 kg, age 27) sneaked out of his house on May 28, 2019 and moved to a motel in another city, and then ate metoclopramide, cimetidine and 20 g of sodium nitrite. No activity after that.
LuxelDrief ate 800 mg of cimetidine, 40 mg of metoclopramide, and some metamizole after fasting for 8 hours on May 31, 2019, and measured sodium nitrite with a 22.5 mL measuring cup and drank it in 70 mL of water. He had a strong salty taste. There was no pain other than a burning sensation in his chest. No activity after that.
Cloudz ate 30 mg of metoclopramide and 800 mg of cimetidine around June 4, 2019, and 20 g of sodium nitrite mixed with 125 mL of water. It had an extremely salty taste, reminiscent of car tires. Five minutes later, he said that his heart rate was slightly faster, but other than that he had no symptoms. No activity after that.
Summarizing the above cases, if a person eats 15 to 20 g of sodium nitrite, if it is detected early and not treated, there is a fairly high probability of death.
Now let's look at the animal test results. Cowled et al. (2008) conducted an experiment to determine the lethal dose of sodium nitrite in pigs with an average weight of 25±11 kg. First, 3 pigs per group were anesthetized and then injected with sodium nitrite by gavage. At doses of 90 mg/kg, 1 of 3 animals died, and at 135 mg/kg and 180 mg/kg, all 3 of 3 animals died. Second, 6 pigs per group were fed a mixture of sodium nitrite in the diet. At 135 kg/kg, 0 out of 6 animals died. At 270 mg/kg, 1 out of 5 animals that had consumed sodium nitrite died, and one animal that did not consume sodium nitrite survived. At 540mg/kg, 4 out of 4 animals that ate sodium nitrite all died (required time: 129±45 minutes) lived by eating. Then, the sure lethal dose of sodium nitrite for pigs is 135mg/kg when administered by gavage, and about 540mg/kg when mixed with feed.
The reason for the difference between the lethal dose during gavage administration and the lethal dose during food administration is presumed to be that the food in the stomach interferes with the absorption of nitrite. The fact that sodium nitrite becomes more toxic on an empty stomach has been consistently shown in other experiments. For example, if 5 g of potassium nitrite is administered to pigs weighing 10 to 20 kg, administration to pigs that are starved for the night will cause death, but administration to pigs that have been devoured causes no symptoms (Gwatkin & Plummer, 1946).
Let's look at another experiment. Shapiro et al. (2015) divided 9 pigs weighing about 33 kg into 3 groups, 3 per group, and placed 2 feeding boxes in each group, and 3 feeding balls in each feeding box. Each food ball weighed 250 g, of which 25 g was sodium nitrite. That is, 1500 g of food balls (150 g of sodium nitrite) were allocated to each group of pigs. Although there is an allotment of 500 g of food balls (50 g of sodium nitrite) per pig, it is not certain that each pig will actually eat as many balls as there is no guarantee that the balls will necessarily be evenly distributed within the group. As a result of the experiment, in groups 1 and 2, all the food balls were consumed and all the pigs died (required time 39 to 93 minutes). Thus, it can be seen that the fatality rate reaches 100% at 1515 mg/kg. In group 3, only 670 g of the total 1500 g of food balls were consumed, and only 2 out of 3 pigs died. If we assume that the three pigs in the group shared the sodium nitrite equally equally, then each pig ate 677 mg/kg. is 812 mg/kg per pig, and 406 mg/kg of live pigs.
If so, it seems safe to catch the sure lethal dose of sodium nitrite for pigs at about 540 mg/kg. In order to simply convert this to a number for humans, it is necessary to multiply the mg/kg value for animals by (animal weight / human weight)¹⁻ˣ. McNeill, 2009). The average weight of Koreans is 66 kg, so we will convert it based on this. Calculating, 540 mg/kg for a 25 kg pig translates to 423 mg/kg for a 66 kg human. The sure lethal dose of sodium nitrite for a 66 kg human would be 25 g.
However, since animals and humans are physiologically different, the simple conversion of lethal dose for animals into lethal dose for humans cannot be considered accurate and requires additional adjustment. The reason why sodium nitrite is toxic is that it makes methemoglobin in the body. Humans have more methemoglobin reductase than pigs, so they have strong resistance to the toxicity of sodium nitrite (Cowled et al., 2008). Therefore, it is reasonable to increase the lethal dose for humans slightly more than for pigs. Referring to the data of Robin & Harley (1966) cited in Cowled et al.'s paper, it seems safe to divide the lethal dose calculated on a pig basis by 0.86. Then the sure lethal dose of sodium nitrite for a 66 kg human would be 25 g / 0.86 = 29 g. The definitive lethal dose for a 75 kg human is 36 g.
There is no guarantee that it is accurate because it is only a value obtained by simply converting an uncertain value obtained from an animal experiment based on body weight and adding a simple adjustment using the value according to the methemoglobin reduction experiment. The lethal dose may also vary depending on how empty the stomach is at the time of ingestion.
pain
Nitrite causes methemoglobinemia. The symptoms of methemoglobinemia are: "When the blood fraction of methemoglobin reaches 10-15%, the first symptom is cyanosis. In more than 20%, anxiety, headache, and dizziness appear, and in 30-40%, symptoms such as headache, fatigue, tachycardia, tachypnea, dizziness, and general weakness appear. In 50-70% of cases, arrhythmias, respiratory failure, hypotension, convulsions, acidemia, and coma may occur. In more than 70% of cases, it is fatal enough to cause cardiac arrest" (Lee Kyung-won and Lee Jae-baek, 2013). When the methemoglobin fraction was 42.2%, some people visited the emergency room with dyspnea as the main symptom (Park Sangsoon et al., 2007).
Other than that, it seems that there are quite a few people who eat sodium nitrite and have severe vomiting. Administration of sodium nitrite to pigs also induced vomiting with a high probability.
Presumably, anxiety (cf. Beck et al., 1999), tachycardia, chest pain, tachypnea, and dyspnea are due to methemoglobin-induced hypoxia, and headache and dizziness are vasodilation of nitric oxide (NO) produced by the metabolism of nitrite. Because of the effect, nausea and vomiting may be due to the action of NO and sodium. Others have experienced severe vomiting by eating large amounts of sodium chloride, not sodium nitrite, for suicidal purposes.*
stomach acid suppressant?
Until the beginning of 2018, PPH is ① to increase the pH of the stomach by drinking 5 g of sodium bicarbonate (baking soda) in water just before sodium nitrite intake to increase the absorption rate of sodium nitrite, ② to increase the pH of the stomach and ② phytic acid (inositol hexaphosphate, IP6). It was proposed to inhibit the action of methemoglobin reductase by eating.
However, sodium bicarbonate appears to have a weakening effect rather than enhancing the toxicity of sodium nitrite. Cowled et al. (2008), when 180 mg/kg of sodium nitrite alone without sodium bicarbonate was administered to pigs by gavage, the average time to death was 52±26 minutes. The average time to death was 87±16 minutes. The survival time was longer in the group receiving sodium bicarbonate. Shugaleĭ et al. (1994) found that administration of sodium bicarbonate before a lethal dose of sodium nitrite to animals prolonged survival time, and that administration of sodium bicarbonate prior to administration of less than a lethal dose of sodium nitrite decreased blood methemoglobin concentration. observed. On the other hand, Kovács et al. (1960) obtained a result that the blood methemoglobin fraction increased from 47% to a lethal level when gastric lavage was performed and sodium bicarbonate aqueous solution was administered before administration of sodium nitrate to pigs, but this is not the effect of sodium bicarbonate. It seems more likely that it is the effect of gastric lavage. As mentioned above, there is a big difference in toxicity between administration of sodium nitrite on an empty stomach and administration with food. Gastric lavage removes food that interferes with the absorption of sodium nitrite and may force a fasting state, so overall toxicity levels may have increased despite administration of sodium bicarbonate.
Phytic acid also appears to attenuate rather than potentiate the toxicity of sodium nitrite. Phytic acid significantly slows the rate of methemoglobin production from nitrite (Tomoda et al., 1977).
Whether the author was aware of these problems, from June 2018, the content of sodium bicarbonate and phytic acid was quietly deleted from the PPH. Instead, it was said, "To speed up the absorption of sodium nitrite, you need to reduce gastric acid secretion, so take 800 mg of cimetidine 30 minutes before your workout."
However, it is also questionable whether cimetidine has the effect of amplifying the toxicity of sodium nitrite. Since the decrease in gastric acid secretion by taking cimetidine is the same as neutralizing gastric acid by taking sodium bicarbonate, it is reasonable to think that if orally administered sodium bicarbonate weakens the toxicity of sodium nitrite, cimetidine will also weaken the toxicity of sodium nitrite. Reasonable.
The article has been transferred to Google Translate.
Source...Internet Blog
Legally, sodium nitrite is a toxic substance according to the Chemicals Control Act. It is legally treated the same as 'cyanide', which was commonly used for suicide in the past, and 'caustic kary' and 'caustic soda' used by housewives to make natural soap at home. . According to the Chemicals Control Act, hazardous chemicals include toxic substances, permitted substances, restricted substances, prohibited substances, and accident preparation substances. Toxic substances are legally available for offline sales to the general public as well as internet shopping sales for the general public (Article 28-2 of the Act). In some cases, the duty to report to the Minister of Environment is imposed only (Article 20(3) of the Act, Article 10(2) of the Decree). Therefore, under the current law, it is impossible to punish those who purchase sodium nitrite for suicide purposes, and it is also impossible to ban the online sale of sodium nitrite on the grounds that it can be misused for suicide purposes. It is thought that it would be preferable to induce self-regulation in the industry rather than a legal approach.
Sodium nitrite and sodium nitrate have similar names but are different substances. It is known to be much less toxic than sodium nitrite. Although in one case, a 23-year-old woman ate an unacceptable amount of sodium nitrate and her methemoglobin concentration rose to 92.7% (Dela Cruz et al., 2018), a 67-year-old man ate 75 g of sodium nitrate and developed vomiting and diarrhea. There was also a case in which nothing happened, and the methemoglobin concentration measured after 4 hours was only 1.8% (Joosen et al., 2014). Successful suicide attempts with sodium nitrate are rare.
lethal dose
The Peaceful Pill Handbook (hereinafter referred to as PPH), the book that led to the first popularization of sodium nitrite suicide method, suggests 20g as the recommended intake (?). Since it is a book that claims to be a suicide note, it can be assumed that the recommended intake is the amount that achieves a 100% success rate, but in fact, that is not certain.
Many suicide manuals, including PPH, have a habit of initially setting the recommended intake of poisons quite conservatively, and then gradually increasing the recommended intake by pretending not to win when the number of people who failed to commit suicide by eating that amount accumulates. Pentobarbital is a drug that has been adopted as an oral euthanasia drug along with secobarbital according to the official guidelines* of the Dutch Medical Association and Pharmacists Association. Secobarbital and pentobarbital were mainly used until the mid-2010s when there was a supply shortage. It is worthy of being called the "gold standard" for suicidal poisons, such as using only barbital. When pentobarbital suicide was introduced in the first edition of Final Exit, the world's most recognizable suicide manual, the Netherlands had already used 9 g since then, but the book suggested 3 g as a lethal dose (Humphry, 1991). In the second edition (1996), it was quietly increased to 6g. In the third edition (2002), it was quietly increased to 9g. The Dutch Medical Association and Pharmacists Association increased the recommended intake of secobarbital and pentobarbital to 15g in 2012. Meanwhile, since the publication of the first edition in 2006, PPH introduced a suicide method using amitriptyline, a tricyclic antidepressant, and suggested 5 g as the recommended intake. Then, in 2017, an elderly woman who was active in Peaceful Pill Forums, a suicide community run by Exit International, a suicide group that publishes PPH, predicted suicide using amitriptyline 5g, and reported that it failed a few days later. Many people were shocked when they committed suicide by jumping from a high-rise building. In the next revision, the recommended intake of amitriptyline was quietly increased to 8g.
A similar thing happened with sodium nitrite. Around the end of 2017, when sodium nitrite suicide was first introduced to PPH, the PPH contained a saying that "only 2.6 g of sodium nitrite is enough for an adult." The decimal point is sufficient to give the impression that the number was scientifically accurately calculated, but in reality it was not. The lethal dose of sodium nitrite of 2.6 g for adults is found on page 1 of a Google search for 'sodium nitrite lethal dose', as reported by Katabami et al. (2016) and Chui et al. (2005) is a number that appears in the paper. Chui et al. (2005) as a basis for that number, Bradberry et al. (1994), this paper, citing the case report of Gowans (1990), says that even 1 g of sodium nitrite may cause death, but the number 2.6 g does not appear at all. After all, 2.6g is a number that has fallen from the air without any scientific basis.
It is a very dangerous attitude to accept this as scientific truth simply because it is a number published in the prestigious Hindu journal, which appears on the first page of a Google search, without such an accurate basis. For decades, it was known that the lethal dose of nicotine for adults was 60 mg. All authoritative medical papers, toxicology textbooks, US government publications, and MSDSs all stated that the lethal dose of nicotine was 60 mg. However, there is no scientific or evidence for this, and it has been recently found that the actual lethal dose is 6.5 to 13 mg/kg or more (Mayer, 2014). This kind of disaster occurs when people repeatedly quote each other based on the authority of the medical literature without properly examining the exact scientific basis for which the numbers were derived.
Maybe that's why PPH changed the lethal dose from 2.6g to 3g at the end of 2017. Perhaps it was not intended to hide the exact source of the lethality number from which paper. After 2018, the recommended intake gradually increased to 5g, 10g, and 15g whenever the monthly revision was repeated, and finally, in early 2019, it increased to 20g. The fact that there was an increase was never announced, and the reason for the increase was never given. The recommended intake for suicide statements is always quietly increased.
If so, what is the lethal dose with scientific evidence? In order to find out, it seems to be necessary to look at ① the successful and unsuccessful cases of sodium nitrite suicide and ② the results of animal experiments on pigs.
Let's look at an example of a suicide attempt with sodium nitrite in real life. First, it is an example from The Peaceful Pill Handbook. In 2018, an adult weighing 46 kg took 15 g of sodium nitrite in 50 mL of water, and became sleepy at 3 minutes, very sleepy at 5 minutes, but still responsive, unconscious at 12 minutes, and unresponsive to stimulation at 15 minutes Cyanosis developed at 25 minutes, shallow breathing, and death at 42 minutes.
The following are examples found in the paper.
A 29-year-old man ate 20-22 g of sodium nitrite and called 911 by himself 5 minutes later. The blood methemoglobin concentration measured at the hospital was 91%. After treatment with methylene blue, etc., he was transferred to a psychiatric ward without any sequelae (Bruccoleri et al., 2016).
A 28-year-old man was taken to the hospital 1 hour after consuming 15 g of sodium nitrite. He was unconscious with GCS 3, and severe cyanosis was observed on the face, lips, and toes, and the blood methemoglobin concentration was 92.5%. He was treated with methylene blue et al and was discharged without sequelae (Katabami et al., 2016).
There was a case of a 76-year-old man who had cardiac arrest 25 minutes after ingesting an unacceptable amount of sodium nitrite (Harvey et al., 2010).
Here are some examples I found on the internet.
21b8fe (weight 80 kg) ate ondansetron on June 17, 2018 to prevent vomiting, and ate 17 g of sodium nitrite mixed with 100 mL of water. After a minute or so, he felt a little sleepy, his toes slightly numb, and his face tightened. He left his last word 4 minutes after eating, and there has been no activity since.
Querry1, a 20-year-old Polish weighing 67 kg, ate 1 g of acetaminophen and drank 15 g of sodium nitrite in 60 mL of water while fasting for 6 hours around July, 2018. She didn't taste good, but it didn't taste that bad either. After 20 minutes, I got nauseous and vomited for a long time in the bathroom. Ten minutes after that, she went to her sister and told her to call 911 because of the unbearable pain (which she said felt similar to the emotional pain of depression). After an hour or so she lost consciousness. 11 hours later, she woke up in the hospital in good condition.
Axorz took metoclopramide, 10 short-acting benzodiazepines, and cimetidine, and 17 g of sodium nitrite while starving for 8 hours on September 24, 2018. He started vomiting as soon as he ate, and he thought something was going wrong, so he went to his family at home. And he lost consciousness as soon as he vomited a second time. The family called an ambulance and woke up in the intensive care unit, intubated into the airway.
Between late 2018 and early 2019, ultraviolet sin took alprazolam, metoclopramide, and 20 g of sodium nitrite in water and ate it in small portions over an hour. There was no vomiting and no pain. I felt drowsy (note: probably due to alprazolam) and numbness in the extremities of my body, but it didn't feel unnatural. It was found and rescued by the police. He had a numb feeling in his shoulder for several weeks, but it went away after that, and other than that, there were no sequelae.
Jen0804 ate cimetidine in an empty stomach on an empty stomach around February 2, 2019 and drank 12 g of sodium nitrite slowly over 15 minutes. Her feeling dizzy and drunk was getting worse and worse to the point where she couldn't even cross her crosswalk. She was found by the police while sitting in front of the church, and was taken to the hospital 20 minutes after ingestion. As her consciousness shifted back and forth, she felt a stabbing pain in her left abdomen, as well as pain in her heart and chest. She was treated and recovered.
Latergator was a 28-year-old male weighing 68 kg and ate 15 g of sodium nitrite in 100 mL of DMSO on February 25, 2019. The taste was disgusting, and I felt a slight burning sensation in my chest. (The burning sensation in the chest area was probably due to the DMSO going down and stimulating the esophagus.) Two minutes later, he said he was lying down in fear. Since then he has not been active.
On March 2, 2019, nintendominos said that they would take metoclopramide and ranitidine, and then sodium nitrite after 30 minutes. No activity since then.
Mich517 ate 20g of sodium nitrite in 100mL of DMSO without taking antiemetics on March 2, 2019, and vomited a significant amount due to vomiting. My vision was blurred, my ears were ringing, I felt like I was about to pass out, I had some convulsions, I felt numb somewhere, my heart rate was fast, my breathing was deep. After that, for some reason, I couldn't hit the keyboard properly. I went to the bathroom with a loss of consciousness and vomited a lot, then fell asleep and woke up. There was no pain at all, and the convulsions did not feel painful at all.
DyingToCTB was administered on March 5, 2019 by taking an antiemetic and cimetidine and adding 20 g of sodium nitrite to 100 mL of water. It was so salty that I had the urge to spit it out, but I resisted it. No activity since then.
Kukubananas, a female weighing 68 kg, took cimetidine, dimenhydrinate, meclizine and 15 g sodium nitrite on an empty stomach on March 11, 2019. She hasn't been active since then.
On April 11, 2019, elfonashelf took metoclopramide 30mg, cimetidine 800mg, and sodium nitrite 15g in 12 OOO size gelatin capsules. Thirty minutes later, she posted a plain, meaningless comment, and there has been no activity since.
TheRiverStyz took 15g of sodium nitrite with temazepam on April 23, 2019. No activity after that.
drakewantstogo took metoclopramide 30mg, ranitidine 225mg and sodium nitrite 17g after fasting for more than 8 hours on April 29, 2019. It tasted like salt sprinkled on car tires. After 5 minutes, severe nausea and a lot of saliva came out. After that, I vomited 3 times. Fifteen minutes later, she should have already lost consciousness, but she wasn't even sleepy, so she thought something was wrong, and she became very uncomfortable and called 911. She was hospitalized and recovered.
Batstern is a 19-year-old male weighing 63 kg, taking 10 mg of metoclopramide every 8 hours for 48 hours before and around May 2019, fasting for 6 hours before running, and then taking the last 10 mg of metoclopramide 1 hour before running. I was planning to take 20g of sodium nitrite after taking 225mg of ranitidine and 225mg of ranitidine, but I was afraid of sodium nitrite and gave up.
Kaluk drank beer after 13 hours of fasting around May 2019, sat on a chair and drank 20 g of sodium nitrite in 100 mL of water. He had a strong salty taste, but was able to swallow it to the end. He felt some nausea and dizziness, but other than that there was no discomfort. After that, he fell unconscious and fell to the front of the chair, pressing the remote control, which made the audio too loud. The police came to the rescue after a complaint from a neighbor who felt dissatisfied with the incident. It was about an hour after he took the medicine. He woke up the next day from the hospital and was forced into a psychiatric ward for two weeks.
Escaper Boy (weight 50 kg, age 27) sneaked out of his house on May 28, 2019 and moved to a motel in another city, and then ate metoclopramide, cimetidine and 20 g of sodium nitrite. No activity after that.
LuxelDrief ate 800 mg of cimetidine, 40 mg of metoclopramide, and some metamizole after fasting for 8 hours on May 31, 2019, and measured sodium nitrite with a 22.5 mL measuring cup and drank it in 70 mL of water. He had a strong salty taste. There was no pain other than a burning sensation in his chest. No activity after that.
Cloudz ate 30 mg of metoclopramide and 800 mg of cimetidine around June 4, 2019, and 20 g of sodium nitrite mixed with 125 mL of water. It had an extremely salty taste, reminiscent of car tires. Five minutes later, he said that his heart rate was slightly faster, but other than that he had no symptoms. No activity after that.
Summarizing the above cases, if a person eats 15 to 20 g of sodium nitrite, if it is detected early and not treated, there is a fairly high probability of death.
Now let's look at the animal test results. Cowled et al. (2008) conducted an experiment to determine the lethal dose of sodium nitrite in pigs with an average weight of 25±11 kg. First, 3 pigs per group were anesthetized and then injected with sodium nitrite by gavage. At doses of 90 mg/kg, 1 of 3 animals died, and at 135 mg/kg and 180 mg/kg, all 3 of 3 animals died. Second, 6 pigs per group were fed a mixture of sodium nitrite in the diet. At 135 kg/kg, 0 out of 6 animals died. At 270 mg/kg, 1 out of 5 animals that had consumed sodium nitrite died, and one animal that did not consume sodium nitrite survived. At 540mg/kg, 4 out of 4 animals that ate sodium nitrite all died (required time: 129±45 minutes) lived by eating. Then, the sure lethal dose of sodium nitrite for pigs is 135mg/kg when administered by gavage, and about 540mg/kg when mixed with feed.
The reason for the difference between the lethal dose during gavage administration and the lethal dose during food administration is presumed to be that the food in the stomach interferes with the absorption of nitrite. The fact that sodium nitrite becomes more toxic on an empty stomach has been consistently shown in other experiments. For example, if 5 g of potassium nitrite is administered to pigs weighing 10 to 20 kg, administration to pigs that are starved for the night will cause death, but administration to pigs that have been devoured causes no symptoms (Gwatkin & Plummer, 1946).
Let's look at another experiment. Shapiro et al. (2015) divided 9 pigs weighing about 33 kg into 3 groups, 3 per group, and placed 2 feeding boxes in each group, and 3 feeding balls in each feeding box. Each food ball weighed 250 g, of which 25 g was sodium nitrite. That is, 1500 g of food balls (150 g of sodium nitrite) were allocated to each group of pigs. Although there is an allotment of 500 g of food balls (50 g of sodium nitrite) per pig, it is not certain that each pig will actually eat as many balls as there is no guarantee that the balls will necessarily be evenly distributed within the group. As a result of the experiment, in groups 1 and 2, all the food balls were consumed and all the pigs died (required time 39 to 93 minutes). Thus, it can be seen that the fatality rate reaches 100% at 1515 mg/kg. In group 3, only 670 g of the total 1500 g of food balls were consumed, and only 2 out of 3 pigs died. If we assume that the three pigs in the group shared the sodium nitrite equally equally, then each pig ate 677 mg/kg. is 812 mg/kg per pig, and 406 mg/kg of live pigs.
If so, it seems safe to catch the sure lethal dose of sodium nitrite for pigs at about 540 mg/kg. In order to simply convert this to a number for humans, it is necessary to multiply the mg/kg value for animals by (animal weight / human weight)¹⁻ˣ. McNeill, 2009). The average weight of Koreans is 66 kg, so we will convert it based on this. Calculating, 540 mg/kg for a 25 kg pig translates to 423 mg/kg for a 66 kg human. The sure lethal dose of sodium nitrite for a 66 kg human would be 25 g.
However, since animals and humans are physiologically different, the simple conversion of lethal dose for animals into lethal dose for humans cannot be considered accurate and requires additional adjustment. The reason why sodium nitrite is toxic is that it makes methemoglobin in the body. Humans have more methemoglobin reductase than pigs, so they have strong resistance to the toxicity of sodium nitrite (Cowled et al., 2008). Therefore, it is reasonable to increase the lethal dose for humans slightly more than for pigs. Referring to the data of Robin & Harley (1966) cited in Cowled et al.'s paper, it seems safe to divide the lethal dose calculated on a pig basis by 0.86. Then the sure lethal dose of sodium nitrite for a 66 kg human would be 25 g / 0.86 = 29 g. The definitive lethal dose for a 75 kg human is 36 g.
There is no guarantee that it is accurate because it is only a value obtained by simply converting an uncertain value obtained from an animal experiment based on body weight and adding a simple adjustment using the value according to the methemoglobin reduction experiment. The lethal dose may also vary depending on how empty the stomach is at the time of ingestion.
pain
Nitrite causes methemoglobinemia. The symptoms of methemoglobinemia are: "When the blood fraction of methemoglobin reaches 10-15%, the first symptom is cyanosis. In more than 20%, anxiety, headache, and dizziness appear, and in 30-40%, symptoms such as headache, fatigue, tachycardia, tachypnea, dizziness, and general weakness appear. In 50-70% of cases, arrhythmias, respiratory failure, hypotension, convulsions, acidemia, and coma may occur. In more than 70% of cases, it is fatal enough to cause cardiac arrest" (Lee Kyung-won and Lee Jae-baek, 2013). When the methemoglobin fraction was 42.2%, some people visited the emergency room with dyspnea as the main symptom (Park Sangsoon et al., 2007).
Other than that, it seems that there are quite a few people who eat sodium nitrite and have severe vomiting. Administration of sodium nitrite to pigs also induced vomiting with a high probability.
Presumably, anxiety (cf. Beck et al., 1999), tachycardia, chest pain, tachypnea, and dyspnea are due to methemoglobin-induced hypoxia, and headache and dizziness are vasodilation of nitric oxide (NO) produced by the metabolism of nitrite. Because of the effect, nausea and vomiting may be due to the action of NO and sodium. Others have experienced severe vomiting by eating large amounts of sodium chloride, not sodium nitrite, for suicidal purposes.*
stomach acid suppressant?
Until the beginning of 2018, PPH is ① to increase the pH of the stomach by drinking 5 g of sodium bicarbonate (baking soda) in water just before sodium nitrite intake to increase the absorption rate of sodium nitrite, ② to increase the pH of the stomach and ② phytic acid (inositol hexaphosphate, IP6). It was proposed to inhibit the action of methemoglobin reductase by eating.
However, sodium bicarbonate appears to have a weakening effect rather than enhancing the toxicity of sodium nitrite. Cowled et al. (2008), when 180 mg/kg of sodium nitrite alone without sodium bicarbonate was administered to pigs by gavage, the average time to death was 52±26 minutes. The average time to death was 87±16 minutes. The survival time was longer in the group receiving sodium bicarbonate. Shugaleĭ et al. (1994) found that administration of sodium bicarbonate before a lethal dose of sodium nitrite to animals prolonged survival time, and that administration of sodium bicarbonate prior to administration of less than a lethal dose of sodium nitrite decreased blood methemoglobin concentration. observed. On the other hand, Kovács et al. (1960) obtained a result that the blood methemoglobin fraction increased from 47% to a lethal level when gastric lavage was performed and sodium bicarbonate aqueous solution was administered before administration of sodium nitrate to pigs, but this is not the effect of sodium bicarbonate. It seems more likely that it is the effect of gastric lavage. As mentioned above, there is a big difference in toxicity between administration of sodium nitrite on an empty stomach and administration with food. Gastric lavage removes food that interferes with the absorption of sodium nitrite and may force a fasting state, so overall toxicity levels may have increased despite administration of sodium bicarbonate.
Phytic acid also appears to attenuate rather than potentiate the toxicity of sodium nitrite. Phytic acid significantly slows the rate of methemoglobin production from nitrite (Tomoda et al., 1977).
Whether the author was aware of these problems, from June 2018, the content of sodium bicarbonate and phytic acid was quietly deleted from the PPH. Instead, it was said, "To speed up the absorption of sodium nitrite, you need to reduce gastric acid secretion, so take 800 mg of cimetidine 30 minutes before your workout."
However, it is also questionable whether cimetidine has the effect of amplifying the toxicity of sodium nitrite. Since the decrease in gastric acid secretion by taking cimetidine is the same as neutralizing gastric acid by taking sodium bicarbonate, it is reasonable to think that if orally administered sodium bicarbonate weakens the toxicity of sodium nitrite, cimetidine will also weaken the toxicity of sodium nitrite. Reasonable.
The article has been transferred to Google Translate.
Source...Internet Blog
