An Accidental Death Due to Ingestion of Isobutyl Nitrite.

Isobutyl nitrite is a malodorous chemical compound that is part of the larger group of alkyl nitrites. This group of chemicals is known to have potent vasodilation effects and, as such, was historically used to treat heart conditions like angina, though these have been replaced by other medications over time. Currently, alkyl nitrites are most frequently encountered as drugs of abuse, as inhalation of the chemicals induces vasodilation, creates a "head rush" and feeling of euphoria, and increases pleasure. While there is some toxicity associated with inhalation, it is generally not considered to be fatal. However, if the nitrites are instead ingested orally, the effects are much more profound, causing severe methemoglobinemia and potentially death. Reports of deaths due to nitrite ingestion are relatively rare overall and frequently are suicidal in nature. We report a death due to accidental ingestion of a vial of isobutyl nitrite with the aim of educating death investigators about the toxicity of this chemical, along with the pertinent autopsy findings and toxicology workup to aid them in the event they encounter such a case.