A) USES: Nitrites are commonly found in the manufacturing industry; they are used in the manufacture of diazo dyes, potassium salts, nitroso compounds, and nitrogen oxide, dyeing and printing textile fabrics, in photography, as reagents in analytical chemistry, as a key chemical in metal treatment and finishing operations, and bleaching flax, silk, and linen. Nitrites are also used in meat curing and preserving, and high inorganic nitrite (KNO2, NaNO
2) levels may be found in well water contaminated by septic tanks, municipal sewage, fertilizers, and feed lots where bacteria reduce nitrates to nitrites. Medically, sodium nitrite is used as an adjunct to disinfectant fluids to prevent rusting of the instruments. Sodium nitrite is also used as an antidote to cyanide poisoning in combination with sodium thiosulfate. Please refer to "SODIUM NITRITE" management for more information.
B) PHARMACOLOGY: Sodium nitrite acts as a vasodilator and relaxes maximally contracted smooth muscles, especially at the level of the small blood vessels. In the setting of cyanide toxicity, sodium nitrite has its therapeutic effect by creating methemoglobin which scavenges cyanide and possibly by increasing hepatic blood flow. Nitrites oxidize normal (ferrous) hemoglobin to ferric hemoglobin (methemoglobin).
C) TOXICOLOGY: Toxic effects of sodium nitrite are caused by an extension of therapeutic mechanisms. Significant vasodilation may cause hypotension and end-organ hypoperfusion. Excess methemoglobinemia may lead to functional hypoxia. The toxic effects of other nitrites are similar to sodium nitrite's effects.
D) EPIDEMIOLOGY: Overdose is rare.
E) WITH POISONING/EXPOSURE
1) MILD TO MODERATE TOXICITY: Hypotension with syncope and tachycardia are common findings in toxicity. Cyanosis may also be noted due to methemoglobinemia. Other common symptoms include headache, nausea, vomiting, and abdominal pain.
2) SEVERE TOXICITY: In cases of severe toxicity, patients may develop severe hypotension, distributive shock, coronary ischemia, cerebrovascular disease, and seizures. Profound methemoglobinemia may lead to respiratory depression, and coma. Death due to nitrite poisoning is caused by uncontrolled vasodilation and hypoperfusion, or by profound methemoglobinemia and functional hypoxia.
0.2.20 REPRODUCTIVE HAZARDS
A) Behavioral deficits were observed in the adult offspring of rats who received sodium nitrite prenatally.
0.2.21 CARCINOGENICITY
0.2.21.2 HUMAN OVERVIEW
A) Sodium nitrite has shown a potential for carcinogenicity in animals.
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