NITRITES, NITRATES

Question 1

Organic nitrates (eg, nitroglycerin,) are widely used as

Answer 1

vasodilators for the treatment of ischemic heart disease and heart failure.

Question 2

Sodium and potassium nitrate and nitrite are used in

Answer 2

preserving cured foods and may also occur in high concentrations in some well water

Question 3

Butyl, amyl, ethyl, and isobutyl nitrites often are sold as

Answer 3

“room deodorizers” or “liquid incense” and sometimes are inhaled for abuse purposes.

Question 4

Clinical presentation

Answer 4

• Vasodilatation
• Vasodilatation may lead to a throbbing headache and flushed face up to rapid fall in blood pressure and shock.
• The heart would compensate by increasing heart rate and force of contraction to elevate blood pressure.
• In severe toxicity, the heart may be unable to respond, leading to hypotension, shock, and cardiovascular collapse.
• Methemoglobinemia.

Question 5

Treatment

Answer 5

A. Emergency and supportive measures (ABCD)
Treat hypotension with intravenous crystalloid fluids, and low-dose vasopressors if needed.
Monitor vital signs and ECG for 4-6 hours.

B. Specific drugs and antidotes. Symptomatic methemoglobinemia may be treated with methylene blue.
C. Decontamination

Ingestion. Gastric lavage if the patient presented within 1-2 hours followed by activated charcoal.

D. Enhanced elimination. Hemodialysis and hemoperfusion are not effective.