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This case report summarizes sodium nitrite toxicity and the mechanism of death following ingestion, then details the fatal poisoning of two sisters occurring within hours of each other. It also examines the role of mental disorders, diagnostic challenges, and the investigative process for determining the manner of death when causality is not obvious.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/double-fatal-sodium-nitrite-poisoning-double-homicide-extended-suicide-or-suicide-and-accident/465157/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/double-fatal-sodium-nitrite-poisoning-double-homicide-extended-suicide-or-suicide-and-accident/465157.png","ImageObject",300,407,{"name":92,"@type":93},"River Wang","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-02","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":34},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why is sodium nitrite poisoning becoming more common?","Question",{"text":112,"@type":113},"Its low cost and ready availability, along with the growth of social media, contribute to the increasing number of intentional poisoning cases.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What mechanism causes death in sodium nitrite poisoning?",{"text":117,"@type":113},"Ingestion induces methemoglobinemia: nitrites oxidize heme iron to Fe3+, producing methemoglobin that cannot effectively transport oxygen to tissues.",{"name":119,"@type":110,"acceptedAnswer":120},"Why can determining the manner of death be difficult?",{"text":121,"@type":113},"The manner of death may not be evident to investigators, and postmortem findings such as lividity color and blood appearance are not always confirmatory, risking misidentification of perpetrators.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},465157,1790825153,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":34,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},1099514067438,"https://ap-avatar.wpscdn.com/avatar/100002539ee87300030?x-image-process=image/resize,m_fixed,w_180,h_180&k=1780474512215547542","Case Report  \nDouble Fatal Sodium Nitrite Poisoning—Double Homicide, Extended Suicide, or Suicide and Accident?  \nAnna Sm˛edra 1, Katarzyna Wochna 1, *, Mateusz Lisowski 2, Agnieszka Skulska-Birgiel 3, Marta Suchan 3 and Jarosław Berent 1  \nAcademic Editor: Vittorio Fineschi  \nReceived: 12 November 2025  \nRevised: 9 December 2025  \nAccepted: 22 December 2025  \nPublished: 24 December 2025  \nCopyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \n1 Department of Forensic Medicine, Medical University of Lodz, Urzednicza 44, 91-304 Lodz, Poland; [anna.smedra@umed.lodz.pl](anna.smedra@umed.lodz.pl) (A.S.); [jaroslaw.berent@umed.lodz.pl](jaroslaw.berent@umed.lodz.pl) (J.B.)  \n2 Toxicology Department, Clinic of Anesthesiology and Intensive Care, Central Clinical Hospital, Medical University of Lodz, Pomorska 251, 92-213 Lodz, Poland; [mlisowski@csk.umed.pl](mlisowski@csk.umed.pl)  \n3 Sehn Institute of Forensic Research, Westerplatte 9, 31-033 Krakow, Poland; [askulska@ies.gov.pl](askulska@ies.gov.pl) (A.S.-B.); [msuchan@ies.gov.pl](msuchan@ies.gov.pl) (M.S.)  \n* Correspondence: [katarzyna.wochna@umed.lodz.pl](katarzyna.wochna@umed.lodz.pl)  \nAbstract  \nRecent years have seen an increasing number of cases of intentional poisoning with sodium nitrite. This is due, in part, to its inexpensive and readily available nature, and to the growth of social media. This paper briefly reviews the toxicity of sodium nitrite and the mechanism of death associated with its consumption and then presents a case of the fatal sodium nitrite poisoning of two sisters within a few hours of each other. It goes on to discuss both the growing problem of mental disorders, particularly among young people, and the potential diagnostic difficulties associated with sodium nitrite poisoning. It also addresses the approach to determining the manner of death, which may not be evident to the investigator; an accurate investigation is, of course, essential, as mistakes can result in the failure to identify the actual perpetrators and even lead to false accusations of guilt.  \nKeywords: accident; extended suicide; homicide; manner of death; methemoglobin; poisoning; sodium nitrite; suicide  \n1. Introduction  \nSodium nitrite (NaNO 2) is a white-yellowish powder with a salty taste, which is readily soluble in water. It has several industrial applications, including its widespread use as a preservative (E250) in food to prevent the growth of anaerobic bacteria (including C. botulinum) . It is readily available over-the-counter and can be easily purchased both as a curing salt, i.e., mixed with table salt, and as a pure chemical reagent. Studies show that regular consumption of even properly cured meat is not associated with acute toxicity, albeit an increased risk of colon carcinogenesis; however, pure sodium nitrite presents a significant risk to health and life, with the lethal dose for an adult being approximately 1 to 2.5 g [1] .  \nWhile cases of unintentional, i.e., accidental, nitrite poisoning have been described for at least 80 years [2–5], clinical practice indicates an increasing number of intentional suicidal poisonings in recent years. Similarly, while few publications have addressed nitrite poisoning, their number increased during the COVID-19 pandemic, and have examined cases in various regions including Asia, Australia, Europe, and North America [6–9], underlining that this is a global phenomenon. Therefore, it is crucial to increase awareness of nitrite poisoning among physicians. Clinicians should be prepared to make a correct  \ndiagnosis and promptly implement appropriate treatment, both at the stage of prehospital care and in hospital emergency departments; in addition, forensic pathologists should be ready to consider the possibility of poisoning, particularly when no identifiable traumatic or disease-relat","cbCair5CtI8e3boQ","https://ap.wps.com/l/cbCair5CtI8e3boQ","pdf",756706,11,"English","# Abstract\n# Introduction\n## Physical and toxicological properties of sodium nitrite\n## Trends in intentional poisoning and the need for clinical awareness\n## Mechanism of methemoglobinemia\n# Diagnostic and investigative implications","[{\"question\":\"Why is sodium nitrite poisoning becoming more common?\",\"answer\":\"Its low cost and ready availability, along with the growth of social media, contribute to the increasing number of intentional poisoning cases.\"},{\"question\":\"What mechanism causes death in sodium nitrite poisoning?\",\"answer\":\"Ingestion induces methemoglobinemia: nitrites oxidize heme iron to Fe3+, producing methemoglobin that cannot effectively transport oxygen to tissues.\"},{\"question\":\"Why can determining the manner of death be difficult?\",\"answer\":\"The manner of death may not be evident to investigators, and postmortem findings such as lividity color and blood appearance are not always confirmatory, risking misidentification of perpetrators.\"}]","Double Fatal Sodium Nitrite Poisoning - Double Homicide, Extended Suicide, or Suicide and Accident | PDF",1790769249,28]