Sodium Nitrite

What is Sodium Nitrite

Sodium nitrite is an inorganic compound with vasodilator properties, used in combination with amyl nitrite and/or sodium thiosulfate as an antidote for cyanide toxicity.

Sodium nitrite is administered after inhaled amyl nitrite, which is administered while the sodium nitrite injection is being prepared. Both sodium nitrite and amyl nitrite oxidize hemoglobin to form methemoglobin which then combines with cyanide to form the relatively non-toxic cyanmethemoglobin.

Following the sodium nitrite injection, sodium thiosulfate is administered to detoxify cyanide by converting it to thiocyanate. This combination is effective in treating cyanide toxicity especially if administered in a timely manner; the effect of combining sodium nitrite and sodium thiosulfate is much greater than using each alone.

Because of its vasodilator properties, researchers are evaluating the efficacy of sodium nitrite in several conditions such as acute myocardial infarction, stroke, sickle cell anemia, and infantile pulmonary hypertension. Sodium nitrite is available as a single agent injectable solution, or in combination with sodium thiosulfate (Nithiodote) or with amyl nitrite and sodium thiosulfate.

Certain food items are capable of inducing symptoms of cyanide poisoning when taken in sufficient quantities. These include bitter almonds, cherry, plum, peach, apricot, cassava, certain bamboo sprouts, and seeds from apples and pears.

Free hydrocyanic acid or cyanogenetic glycosides are produced by certain plants and can be a source of cyanide toxicity. It is believed that hydrocyanic acid is formed because of an inability of the plant to convert all of the available amino acids into proteins. Therefore, production of hydrocyanic acid is a side reaction of protein metabolism.

Livestock deaths due to hydrocyanic acid have also been associated with consumption of chokecherry, arrow grass, Sudan grass, and sorghum; chokecherry has also been reported to cause toxicity in humans. Hydrocyanic acid is also used as a fumigant. It is very effective in fumigating ships, army posts, navy stations, large buildings, flour mills, and private dwellings infested with mice, rats, moths, bedbugs, cockroaches, or carpet beetles.

Hydrocyanic acid is further used for control of scale insects on citrus trees. Various commodities including nutmeats, beans, peas, seeds of different kinds, and baled cottons, are fumigated with hydrocyanic acid in vacuum chambers.

Other sources of cyanide include sodium or potassium cyanide used in metallurgy for extraction of gold and silver from their ores; in electroplating; for cleaning of metal by both the dip and electrolytic processes; for organic synthesis; for dehairing hides; and for partial sterilization of soil.

Indications & Dosage

  • cyanide toxicity

For sequential use with sodium thiosulfate for the treatment of acute cyanide toxicity that is deemed serious or life-threatening

NOTE: Sources of cyanide poisoning include hydrogen cyanide and its salts, cyanogenic plants, aliphatic nitriles, exposure to fire or smoke from an enclosed area, and prolonged exposure to sodium nitroprusside.

Side Effects

  1. coma
  2. cyanosis
  3. dizziness
  4. flushing
  5. headache
  6. hemolytic anemia
  7. methemoglobinemia
  8. nausea
  9. ocular hypertension
  10. orthostatic hypotension
  11. peripheral vasodilation
  12. psychosis
  13. rash
  14. restlessness
  15. sinus tachycardia
  16. syncope
  17. vomiting

Monitoring Parameters

  • arterial blood gases (ABGs)
  • methemoglobin

Contraindications

  • acute myocardial infarction
  • anemia
  • breast-feeding
  • cardiomyopathy
  • cerebrovascular disease
  • dehydration
  • geriatric
  • glaucoma
  • head trauma
  • heart failure
  • hepatic disease
  • hepatitis
  • hyperthyroidism
  • hypotension
  • hypovolemia
  • increased intracranial pressure
  • intracranial bleeding
  • methemoglobinemia
  • nitrate hypersensitivity
  • orthostatic hypotension
  • pregnancy
  • renal disease
  • renal failure
  • renal impairment

nteractions

No information is available regarding drug interactions associated with Sodium Nitrite

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