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Abstract
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Two cases of acute nitrite poisoning occurred in California in June in Filipino patients from Los Angeles County. The cases appear to be related to an outbreak that occurred in March 1975, in which 19 members of the local Filipino community had ingested sodium nitrite mislabeled as monosodium glutamate (MSG).
The patients, husband and wife, were admitted on June 3, 1976, to the Los Angeles County/University of Southern California Medical Center, suffering from severe methemoglobinemia. The woman told emergency room physicians that she had found a bag of what appeared to be table salt in her kitchen and that she had sprinkled the substance liberally on the eggs she and her husband ate that morning. Within 10 to 15 minutes symptoms typical of nitrite poisoning, including marked cyanosis, appeared.
Emergency room physicians, recalling the 1975 outbreak that was traced to a market that sold sodium nitrite mis- labeled MSG, conferred immediately with county epidemiologists and food and drug investigators. Another member of the household who might have eaten some the the "salt" was contacted and placed under observation; he did not be- come ill. A sample of the substance was studied and found to be strongly positive for nitrites. A search of a market where the material might have been recently purchased revealed no other such products.
The patients recovered completely following supportive and intravenous méthylène blue therapy. No additional cases of nitrite poisoning have been reported. Editorial Note: This couple's bag of sodium nitrite was probably one of the estimated twelve 11-ounce bags (of a total of 145) that were not located in the extensive search that followed the original incident. Their bag was identical to those recovered in the earlier outbreak. The wife said she had shopped at the market where those bags were sold during the time when sodium nitrite was available in bags mislabeled MSG. The patient had cleaned out her kitchen the day before her illness and, in her words, "may have found the bag" at that time.
Acute methemoglobinemia is caused by exposure to certain drugs or chemicals which oxidize hemoglobin to a form which is incapable of binding oxygen. Agents which can cause this syndrome include nitrites, anilene, nitrobenzene, hydroquinone, napthylamine, acetanilid, and other oxidizing chemicals.
This incident points up the benefits of having clinicians and field investigators combine their resources to rapidly evaluate a potential community health hazard. |