Amid an uptick in U.S. adolescents attempting suicide by using sodium nitrate and nitrate -- chemical compounds commonly used in food preservation -- researchers found several trends regarding affected youth, in a recent study.
Kids who died by sodium nitrate poisoning skewed older compared with kids who used other means (62% were 17- to 21-year-olds vs 36% in the non-sodium nitrate group). White kids comprised the majority of both groups (62% vs 73%, respectively), but Asian kids had the second highest prevalence in the sodium nitrate group (24%) while Black kids did in the non-sodium nitrate group (12%), according to Frank Pleban, PhD, of Tennessee State University in Nashville.
Notably, a higher proportion of kids in the sodium nitrate group had been hospitalized for mental health concerns in the year prior to their death compared to the non-sodium nitrate group (20% vs 9%). They were also more likely to have seen a healthcare provider within a month of their death (13% vs 8%) and more likely to have had a mental health emergency department visit in the year before their death (13% vs 9%), Pleban reported at the American Academy of Pediatrics annual meeting.
Kids who died by sodium nitrate poisoning were also less likely to have received mental health services than those who died by other methods (21% vs 26%), and were less likely to have had a history of substance use (6% vs 22%), or to have experienced maltreatment (6% vs 21%).
"There are a variety of prevention opportunities resulting from this work, including increasing awareness about the growing use of sodium nitrate and nitrate in self-harm, providing suicide prevention resources that specifically address this method, and informing the public about the ease of access to these chemical compounds online," Pleban said in a press release.
Sodium nitrate and nitrate can be easily purchased online as meat curing ingredients, and when ingested in certain quantities, can cause methemoglobinemia, leading to hypoxia and eventual death, he said during his presentation.
The findings on sodium nitrate and nitrate come amid recent concern regarding poisoning and youth suicide.
For instance, from 2000 to 2023, exposures to medications, dietary supplements, or psychoactive substances grew among kids, especially those exposures associated with suspected self-harm or suicidal intent, according to data from U.S. poison centers.
Increased rates of suspected suicide attempts by poisoning among kids and adolescents during the pandemic were also reported.
Pleban noticed a rise in using sodium nitrate and nitrate in suicide attempts when looking over data from the last few years, and said that addressing this method should be part of a broader public health approach to suicide prevention.
"In terms of prevention, it's limiting access and making sure that, when an overdose occurs, people are aware that it might be this substance," psychologist Julie Cerel, PhD, of the University of Kentucky in Lexington, who was not involved in the study, told MedPage Today.
As for different methods of suicide, there is a "moving target," she said, and this "calls for the need to have upstream prevention," including having recent healthcare visits focused on mental health.
For the study, researchers compared suicide deaths in 14- to 21-year-olds from sodium nitrate and nitrate with youth suicide deaths from other methods. Deaths occurred between 2018 and 2023, and were documented in the Pediatric National Fatality Review-Case Reporting System. There were 34 deaths in the sodium nitrate group and 4,544 deaths in the non-sodium nitrate group. Males represented 71% and 73% of the groups, respectively. Mean age was similar for both (16.7 years vs 16 years).
Additional studies are needed to examine the impact of safety interventions on the incidence of sodium nitrate and nitrate self-poisoning, Pleban noted.
Disclosures
The authors of the study reported receiving support from the Health Resources and Services Administration.
Pleban and Cerel did not report any relevant conflicts of interest.
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