Sodium Nitrate, Sodium Nitrite and Helium: Grand Rounds 2022


When: This event originally occurred on June 17th, 2022.

Presenter: Dr. Amy Rapkiewicz , Chair of Pathology, NYU Langone, NY


In the global market, access to chemical and simple asphyxiants have changed the landscape of forensic pathology. Expert diagnostic reasoning of forensic pathology cases requires scene investigation, autopsy findings, medical knowledge, technical and toxicology findings and laboratory data similar to clinical medicine. Creating illness scripts for decision making modest to support this reasoning is a process which requires a community and case examples.

This talk aspires to begin the process of creating illness scripts and diagnostic reasoning models for chemical and simple asphyxiant deaths. Highlighting historical context, scene investigation findings, pathophysiology, societal and forensic context, toxicology and laboratory date will begin to creating schemas for cause and manner of death investigation and determination.

Chemical and Simple asphyxiants are rising in numbers as important suicidal agents. The generalization of availability of products is influenced by ease of use and access. Chemical asphyxiants such as sodium nitrite is readily available on-line and is a rapid and easy method for intentional ingestion. Other chemical asphyxiants such as alkyl nitrities have a rich history in LGBTQ and party culture and are typically accidental deaths.

Simple asphyxiants such as helium, similar to chemical asphyxiants are gaining popularity as suicidal agents due to availability and ease of use as well as online instruction. Toxicologic testing is challenging in these cases but can be performed with adaptation of carrier gas in toxicology lab machines.


Detailed Learning Objectives:

•Review the Mechanism of Nitrites in Hypoxia

•Relate the Societal and Forensic aspects of Nitrite intoxication

•Discuss the Context of Inhalational Asphyxia

•Review the Mechanism of Helium in Hypoxia

•Discuss the Forensic aspects of Nitrogen, Helium and Argon intoxication


*Funding for this training was made possible by a cooperative agreement between the National Network of Public Health Institutes and the Centers for Disease Control and Prevention [6 NU38OT000303-03-02]. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Centers for Disease Control and Prevention nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.


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