Nitrates and Nitrites

1. Inorganic nitrates: sodium nitrate{ tastes like sodium chloride, used by weavers as a mordant}, potassium nitrate, silver nitrate
2. Organic nitrates: nitroglycerin, iso sorbide dinitrate
3. Inorganic nitrites: amyl nitrite, isobutyl nitrite, sodium nitrite
4. Organic nitrites: bismuth sub nitrate in contaminated well water may be converted by intestinal bacteria into nitrites and causes poisoning

Route :
Ingestion
Fatal Dose :
sodium nitrate - 1 to 2 gms, nitroglycerin – 200mg, silver nitrate – 2 to 10 gms
Fatal Period :
few hours to few days
Mechanism of action :
Sodium nitrate causes relaxation of smooth muscles, especially of blood vessels and in toxic doses comnerts hemoglobin to methemoglobin

Clinical Picture :
• Throbbing headache, vertigo, low BP, palpaitations,
• cold and cyanotic, nausea , vomiting, diarrhea, syncope
• cyanosis, anoxia
• Hyperapnoea, later dyspnoea, slow pulse, increased intracranial tension
• paralysis, convulsions, coma

Treatment :
• Emesis
• Gastric lavage
• If methhemoglobinemia More than 30 percent, inject methylene blue {1 percent soln} or 1 to 2 mg, kg orally
• Exchange transfusion, especially in infants
• Symptomatic

Nitrates and Nitrites

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