Sodium Azide Poisoning

Aka: Sodium Azide Poisoning, Sodium Azide

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II. Mechanism

  1. Sodium Azide Description
    1. Odorless white crystalline powder
  2. Sodium Azide Activity
    1. Cytochrome oxidase inhibitor
      1. Nitridizing agent
      2. Terminal oxidation inhibitor (blocks Oxidative Phosphorylation)
      3. Results in cellular asphyxia
    2. Increases cyclic guanosine monophosphate (via guanylate cyclase activation)
  3. Sodium Azide Industrial Use
    1. Antimicrobial preservative (labs)
    2. Explosive detonator
    3. Air Bag propellant (older Air Bags)
    4. Agricultural Pesticide

III. Toxicity

  1. Very dangerous chemical in humans
  2. Lethal dose <1 grams

IV. Symptoms

  1. Dizziness
  2. Headache
  3. Nausea and Vomiting
  4. Dyspnea

V. Signs

  1. Tachycardia
  2. Hypotension (within minutes of ingestion)
  3. Pungent, toxic odor
    1. Hydrazoic acid fumes (released on ingestion and acidification of Sodium Azide)

VI. Labs

  1. Serum Lactic Acid
    1. Increased
  2. Basic chemistry panel
    1. Metabolic Acidosis
    2. Hyperkalemia

VII. Management

  1. Staff should wear Personal Protection Equipment
  2. Patient Decontamination
    1. Remove and bag clothing
    2. Rinse patient of any remaining Sodium Azide (powder, vomit)
    3. Consider Activated Charcoal in early presentations after ingestion
  3. Aggressive supportive care
    1. Intravenous Fluids
    2. Airway management
    3. Vasopressors (Norepinephrine) for refractory Hypotension
  4. Consider Hemodialysis or plasma exchange

VIII. References

  1. Tomaszewski (2019) Crit Dec Emerg Med 33(9):32

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