A woman with pallor, cyanosis, and bounding peripheral pulses immediately after overdose

A39-year-oldwomanpresentedbyambulance20minutes after ingesting 4 tablespoons of sodium nitrite in a suicide attempt. Presenting vital signs included: pulse 139 beats/min, blood pressure 117/ 48mmHg, respiratory rate 24 breaths/minute, pulse oximetry 83% on 15L/minuteoxygenandGlasgowComaScale15. Examination revealed cyanosis and pallor (Figures 1 and 2) with bounding peripheral pulses. Five minutes after arrival, the patient had generalized tonic-clonic seizures and was intubated. Activated charcoal and antidotal therapy were administered, and gastric lavage was performed. Blood appeared dark brown on arterial puncture (Figure 3).