Podcast 793: Atypical Toxicology Overview in SI - The Emergency Medical Minute

Podcast 793: Atypical Toxicology Overview in SI

Contributor: Aaron Lessen, MD

Educational Pearls:

  • There are several online products that have been marketed towards individuals with SI
  • Sodium nitrite
    • Food preservative that can cause methemoglobinemia when ingested in large amounts
    • Patients present with blue skin discoloration and severe respiratory distress
    • Treat with methylene blue to reduce methemoglobin back to hemoglobin
  • Formic acid and sulfuric acid¬†
    • These two acids can be combined in a confined space to create a potentially lethal exposure to carbon monoxide
    • Patients present with symptoms of CO poisoning as well as possible chemical burns and inhalation injuries
    • Patients require decontamination and treatment for CO poisoning in the emergency department
  • Hydrogen sulfide
    • Toxic gas that is produced from combining strong acid (toilet bowl cleaner) and a sulfur containing product (selenium sulfide shampoo and sulfa drugs)
    • “Knock down gas” that causes cyanide toxicity that rapidly affects anyone exposed to it including family members and rescuers


Kreutz K, Danielsen T, Quinton RA. Suicidal Carbon Monoxide Poisoning by Formic and Sulfuric Acids. Acad Forensic Pathol. 2019;9(3-4):217-224.

McCann SD, Kennedy JM, Tweet MS, Bryant SM. Sodium Nitrite Ingestion: an Emerging Trend in Suicide Attempts Shared via Online Communities. J Emerg Med. 2021;60(3):409-412.

Sams RN, Carver HW, 2nd, Catanese C, Gilson T. Suicide with hydrogen sulfide. Am J Forensic Med Pathol. 2013;34(2):81-82.


Summarized by Mark O’Brien, MS4 | Edited by John Spartz, MD & Erik Verzemnieks, MD


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