Finding into death of BT

25y · Male·Multiple system failure and ingestion of sodium nitrite

BT, a 25-year-old man with bipolar affective disorder and long-standing depression, died from intentional sodium nitrite ingestion while an inpatient in the Behavioural Assessment Unit at Royal Melbourne Hospital. He presented to the ED with suicidal ideation and was admitted for overnight observation. He smuggled sodium nitrite into his room and ingested it at 10:03pm. He deteriorated to cardiac arrest at 10:26pm. The critical delay in treatment occurred because venous blood gas results showing severely elevated methaemoglobin (70-86%) were not configured to display reference ranges and were not transmitted to the laboratory information system, so the abnormal result was not recognized until 12:22am when an arterial blood gas was processed. Methylene blue treatment was thus delayed by nearly 2 hours, missing the window for potentially preventing hypoxic brain injury. The hospital has since implemented automated flagging of abnormal methaemoglobin levels. Clinician education about methaemoglobinaemia recognition is essential given increasing sodium nitrite suicides.