Nitrate and nitrite poisoning

Sometimes, when eating fresh food products, you may encounter an unusual reaction of the gastrointestinal tract to them. Everything on the table seemed to be fresh, but symptoms of poisoning are evident. Most often, this happens in the spring-summer period, as well as during the New Year holidays, when it is so difficult to deny yourself the alluring off-season vegetables and fruits from the shelves. We buy them for ourselves, give them to our children, and then are sincerely surprised when the doctor diagnoses nitrate poisoning. But what is there to be surprised about, didn’t we know that all early vegetables and fruits are such thanks to nitrogen fertilizers, i.e. nitrates.

Nitrates: benefits and harms

In fact, nitrates, or nitrogen salts, can hardly be called poison, since plants do not die from them, but on the contrary, they begin to grow actively, turn green, bear fruit, which is distinguished not only by its attractive appearance, but also quickly fills out and ripens. It turns out that nitrogen is food for plants. It is thanks to its salts that plants can grow and fruits can ripen.

But where do plants get nitrogen salts? Of course, in the soil and the water we water them with. Usually the soil contains enough nitrates, we get the harvest on time and are quite happy with it. If there are not enough nitrates, the plants are puny, do not bear fruit, or their harvest is very unsightly (fruit is small, dry, irregularly shaped). In this case, adding nitrogen fertilizers to the soil is quite justified, which is what we observe in agriculture.

True, every owner strives not only to have a good harvest, but also to get it before others in order to sell it at a higher price. This can be done by increasing the dose of fertilizer. Fertilizers are especially important for plants grown in unnatural conditions, for example, in greenhouses under artificial lighting. Without nitrates, you can wait a very long time for fruits from them.

But the fruits obtained in this way will be dangerous for those who will subsequently consume them, because they accumulate the bulk of nitrates. Nitrates are localized near the peel of the fruit, gradually breaking down during long-term storage (in six months of storage, vegetables lose from 40 to 80% of nitrogen salts and become less dangerous).

Nitrates are always present in small quantities in plants, because they participate in the construction of cellular structures. It is just that a small content of these substances is natural and does not harm the human body. Moreover, our body also contains nitrogenous salts that circulate with the blood and participate in protein synthesis and metabolism. The body itself produces them, but does so in a strictly regulated manner so as not to harm itself.

It turns out that all living beings contain nitrates in one quantity or another. And as long as humans do not interfere, there is a balance in nature that does not harm anyone.

But people are curious creatures, and once they learn the properties of nitrates, they rush to use them in various industries: in medicine for making medicines, in the food industry as a preservative and a component that gives meat products an attractive pink color, in agriculture to obtain large and early harvests. By abundantly fertilizing the soil, we agree that some of the fertilizers will eventually pass into the water that we will drink and water all the same "nitrate" plants, increasing the content of nitrogen salts in them.

It is difficult to even imagine how many nitrates, in addition to their own, accumulate in our body. But they really do accumulate, poisoning us, people who gave them such an opportunity. The use of water and food products of large quantities of nitrogenous salts causes nitrate poisoning, when symptoms of intoxication are caused by the use of seemingly fresh products.

But why don't the plants die in that case? The thing is that they deal with nitrates, which are not poisonous in themselves, but in our bodies, under the influence of saliva and some enzymes, nitrates can turn into nitrites, which are considered to be quite toxic chemicals.

Causes nitrate poisoning

The only cause of poisoning with nitrates, which are not toxic substances, can only be their overdose. Like some other substances present in our body, nitrates are harmful only in large doses. And an increase in the content of methemoglobin (which we owe precisely to nitrates converted into nitrites) over 1% can already be considered an overdose, although not dangerous.

According to the documents of the World Health Organization, no more than 3.7 mg of nitrates per kilogram of human weight should enter the human body per day. That is, a person weighing 50 kg should receive no more than 185 mg with food, and if the body weight is 90 kg - no more than 333 mg. In this case, the nitrite content will be less than 0.2 mg per kilogram of weight, which is quite safe for the body even though we have our own nitrites.

But in reality it often turns out that we consume much more nitrates, and sometimes we ourselves do not understand what is causing the deterioration in health until it becomes unbearable, because nitrates tend to accumulate in the body. And, despite the fact that nitrates can be found virtually everywhere: in vegetables and fruits, meat, water, etc., most often we are dealing with chronic poisoning.

That is, we buy and eat products with an increased content of nitrates and notice unpleasant symptoms such as headaches and weakness, but do not associate them with an overdose of nitrogen compounds. But this is until it reaches a certain limit and not only the brain, but also our other organs begin to experience noticeable oxygen starvation, which will affect their work.

But nitrate overdose can also be acute if a large amount of these substances enters the body at one time. Risk factors for acute poisoning can be:

• drinking water from reservoirs where runoff from fields fertilized with nitrates has entered,
• handling nitrogen fertilizers and swallowing them due to poor hand hygiene or by pure accident,
• the use of ready-made meat and sausage products with a beautiful pink hue, which is obtained not thanks to dyes, but as a result of the use of nitrates as a preservative,
• treatment with medications containing nitrates, for example, the same nitroglycerin.
• the use of gifts of nature, which we humans have turned into poison in pursuit of large and early harvests.

But let's figure out whether all of the above are equally dangerous. Let's start with water. How likely is it that a person will drink water from an ordinary river or pond? Probably, this will be more of an exception. Cattle, whose meat may later end up on our table, will drink such water faster.

Some nitrates may also end up in groundwater, which supplies life-giving moisture to reservoirs used for drinking water. But the level of nitrates in drinking water is usually controlled, and it is unlikely that you will get seriously poisoned by drinking it, unless nitrites accumulate in the body over a long period of time.

But such sources of drinking water as wells and springs, which ideally should contain no more than 50 mg of nitrates per 1 liter, in reality exceed the norm by 10 or more times, so it is not surprising when rural residents end up in hospital with nitrate poisoning. Small children, whose bodies do not yet produce enzymes capable of converting methemoglobin into hemoglobin, are most often hospitalized with acute symptoms. Poisoning as a result of drinking water in adults is rare.

When working with nitrogen fertilizers, the risk of poisoning is quite high if safety precautions are not followed. It is also important to store chemical plant fertilizers correctly so that they do not end up near food or drinking water.

As for ready-made meat products, the amount of nitrates in them is not so great as to cause serious poisoning. Probably, a person's stomach will stop from being overloaded with store-bought meat dishes faster than symptoms of nitrate poisoning will appear. We don't eat sausages and bacon by the kilogram, which may save us from acute oxygen deficiency caused by intoxication with nitrogen salts. Nevertheless, the risk of chronic intoxication from the abuse of sausages with nitrates is still high.

The story with medicines is somewhat different. "Nitroglycerin", "Isosorbide dinitrate", "Isosorbide mononitrate", "Isocardin", "Nitrong" and other medicines containing organic nitrates, which are used for heart diseases, are used with special caution. A slight excess of the dose immediately causes headaches and tachycardia, characteristic of mild methemoglobinemia.

Since nitrates have vasodilatory properties, some patients experience a drop in blood pressure, which is accompanied by weakness, dizziness, and sometimes temporary loss of consciousness. However, serious methemoglobinemia, and especially poisoning with nitrates in drugs, occurred only in the treatment of the youngest patients.

As sad as it may be, it turns out that vegetables, fruits and berries remain the main source of nitrates for humans. But if we consider that nitrogen fertilizers are usually used to feed vegetable and melon crops, we can expect that the nitrate content in them will be especially high.

According to research and poisoning statistics, elevated levels of nitrates can be detected:

• in greenhouse vegetables (usually in cucumbers and tomatoes, which end up on our table long before the ground vegetables ripen),
• early greens and those that can be found fresh in stores on the eve of the winter holidays (these are not the greens that each of us could grow on a windowsill without nitrates, but few people practice this),
• root crops: potatoes, beets, carrots, radishes, radishes (for this reason, it is not recommended to buy too large specimens that have become so due to nitrogenous fertilization, because every producer tries to get a good harvest, but in what ways?!),
• cabbage, which in unfertilized soil turns out with small heads, or even without ovaries (natural fertilizers attract pests that damage the plant's roots, so it is easier to use chemical fertilizers, which both scare away pests and promise a rich harvest),
• melons and gourds (melons and watermelons).

But again, in most cases we heat treat root vegetables, which destroys some of the nitrates. If a dish requires peeled vegetables (and nitrates accumulate in the upper layers of the fruit), then some of the nitrogen compounds go into the trash with the skin.

We usually remove the top leaves from cabbage, which may be dirty and damaged by various pests, and throw away the stalk, which contains no fewer nitrates (alas, not everything and not always).

What remains are greens, the nitrate content of which is relatively low, greenhouse vegetables and delicacies from the melon field. It must be said that our people treat greenhouse vegetables with great caution, understanding what they are stuffed with, so such products rarely end up in the stomachs of children. And adults rarely abuse off-season vegetables, especially considering their high cost.

There are melons and gourds left. This is where the main danger lies. Nitrate poisoning from eating a watermelon that appeared on the table ahead of time is considered almost a common occurrence. And this is not surprising. A watermelon, especially an early one, is a fairly large berry that takes on a large amount of nitrates. A cut watermelon does not last long, so the whole family has the opportunity to eat their fill on the very first day. But will she end up in a hospital bed? This depends on the "generosity" of the melon workers who feed the future harvest.

Usually watermelons and melons with nitrates appear shortly before the bulk of melons begin to ripen. It is difficult for a person to understand whether there was a point in stuffing the plant with nitrates or whether the ripeness was caused by intense heat. So buying early melons is always a risk.

It is clear that the amount of nitrates in ripe fruits depends not only on the amount of fertilizer applied, but also on the time of its application. It is advisable to fertilize plants before fruiting, then the nitrate content in vegetables will not be too high. But in pursuit of a good harvest, some unscrupulous farmers apply fertilizers later, and their products subsequently become poison for other people.

The weather also plays a role. If spring and summer do not please us with warm sunny days, plants absorb nitrates worse, which are converted into proteins only under the influence of high temperatures. It turns out that fruits collected in cool, humid years will have a higher content of unchanged nitrogen compounds, an overdose of which causes nitrate poisoning.

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Pathogenesis

What do nitrites do? The pathogenesis of nitrate poisoning is such that, when converted into nitrites and entering the blood, they bind with hemoglobin, and as a result of the reaction, methemoglobin is formed. But if normal hemoglobin in the lungs is enriched with oxygen, turning into oxyhemoglobin, and carries it throughout the body, ensuring cellular respiration, then methemoglobin is not able to attach oxygen molecules. It, like oxygenated hemoglobin, circulates in the blood, but remains useless.

The more nitrates enter the body, the higher the probability of increasing methemoglobin, which should be no more than 1%, which is considered normal. Since nitrates are always in the body.

When the amount of methemoglobin approaches 15-20%, a person begins to feel weak and tired, headaches appear, fatigue occurs quickly, the pulse becomes more frequent, which is caused by the onset of hypoxia of the organs and tissues of the body.

A further increase in methemoglobin aggravates these symptoms, causing shortness of breath, convulsions, heart problems, etc. When the content of oxy- and methemoglobin equalizes, acute oxygen deficiency occurs, leading to the death of the patient.

The body of an adult is able to stand up for itself, converting some of the methemoglobin into normal hemoglobin using enzymes, thereby reducing the intensity of intoxication symptoms. In the body of a small child, reverse transformations are not observed, so children tolerate nitrate poisoning more severely than adults, and the percentage of fatal outcomes is higher, although there are no exact statistics on this matter. It is only known that the number of poisonings increases when early vegetables appear, as well as on holidays, because you really want to decorate the holiday table with off-season ripe cucumbers and tomatoes grown on nitrates in greenhouse conditions.

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Symptoms nitrate poisoning

Each person's body is individual, and the amount of nitrates that enter the body can vary significantly. This leads to the fact that the symptoms of the disease in different people can have different manifestations.

In case of severe poisoning with nitrogen compounds, the first signs can be expected after 2-4 hours. As with any poisoning, there will be reactions from the gastrointestinal tract. This is mainly the appearance of nausea, vomiting and diarrhea. At the same time, liquid stool sometimes has a pronounced brown tint, reminiscent of the color of chocolate, which indicates the presence of blood in the feces. Painful spasms are felt in the abdomen.

All these symptoms, which appear when the methemoglobin level is more than 15%-20%, are very similar to food poisoning caused by stale or poor-quality food. But there are other symptoms specific to poisoning with nitrogen salts:

• The skin of the victim's face becomes very pale with a noticeable blue tint, which indicates developing hypoxia. The blueness of the lips and nasolabial triangle is especially noticeable. The fingertips also turn blue, while the nails acquire an unusual bluish tint.
• But the whites of the eyes begin to turn yellow, which indicates problems with the liver. This is confirmed by a feeling of heaviness and pain in the location of the organ.
• In addition, a person feels unusual weakness, gets tired quickly, and is sleepy.

At the next stage, when the concentration of methemoglobin increases to 35-40%, the patient begins to complain of dizziness, headaches, tinnitus, his temperature may rise and problems with coordination of movements arise. There are failures in the work of the cardiovascular and respiratory systems, which is manifested by shortness of breath, attacks of suffocation, tachycardia, decreased blood pressure, and heart rhythm disturbances.

Then drowsiness can be replaced by increased agitation, the person develops convulsions, and episodes of loss of consciousness are possible. At a methemoglobin concentration of 45-50%, the patient can fall into a coma or die due to failure of vital organs and systems.

If nitrate poisoning occurs due to water that has an elevated nitrogen content, symptoms usually occur earlier, after one hour. Harmful substances from water enter the intestines and are absorbed faster than from food and medicines.

These are the symptoms of acute poisoning. It is simply impossible not to pay attention to them. But quite often we do not even suspect nitrate poisoning if no surprises arise after eating. Food may not contain critical doses of nitrates, so acute poisoning does not occur. But nitrogen salts gradually accumulate in the body, and the useless methemoglobin they form displaces normal forms of hemoglobin that bind oxygen molecules.

Over time, methemoglobin increases and the blood no longer provides normal cellular respiration. The brain and nervous system suffer primarily from hypoxia, so a person begins to feel an incomprehensible weakness, sometimes he feels dizzy, chronic headaches in the occipital part may appear, work capacity deteriorates, and mood worsens. Metabolic disorders due to hypoxia lead to a lack of useful vitamins and minerals in the body, weakening of protective functions.

But such non-specific symptoms are unlikely to suggest poisoning. A person with chronic nitrate poisoning usually consults a doctor at the stage when malfunctions in various organs and systems begin.

All of the above applies to adults. But nitrates can also harm small children. Parents, without even knowing it, can stuff their baby with hidden nitrates:

• in milk formulas if water with a high content of nitrogen salts was used for their preparation,
• in vegetables included in complementary foods,
• in juices from vegetables and fruits grown in violation of the norms for nitrate content, i.e. with an overdose of fertilizers.

Older children can simply swallow the fertilizer, which they find in the form of small white grains on the ground or in their grandparents' barn, mistaking it for food. Little children are very curious and try to taste everything. And even if the salty taste of nitrates is not to their taste, and the child spits out the tasteless "candy", some of the substance will still get into the immature body.

Nitrate poisoning in children follows a slightly different pattern. Adverse reactions from the gastrointestinal tract (vomiting and diarrhea) are usually not observed, which complicates diagnosis somewhat. After all, many of us believe that poisoning must necessarily be accompanied by a triad of symptoms: diarrhea, nausea with vomiting, and abdominal pain.

In general, the clinical picture of poisoning in a child speaks more about oxygen deficiency and damage to the central nervous system. It all begins with blue lips and nail beds and decreased mobility of the baby, who becomes apathetic, lethargic, sleeps a lot and does not play. Such symptoms appear when the concentration of methemoglobin in the child's blood approaches 10%. Then shortness of breath appears, coordination of movements is impaired, and convulsive syndrome occurs.

Parents may notice that the baby's arms and legs have become cold, and the liver is slightly enlarged (can be determined by palpation). These symptoms should definitely be alarming, because the dose that is considered acceptable for an adult can be fatal for a child whose weight is much less, and the body has not yet learned to defend itself from nitrites. Thus, severe poisoning with nitrites, threatening life, is recorded in children when the percentage of methemoglobin exceeds 30%.

Nitrate poisoning during pregnancy is no less dangerous. During this period, expectant mothers need to be very careful in choosing food and drink, because all those harmful substances that enter the mother's body are transmitted to the fetus in her womb with the blood. And what does hypoxia of the brain (and it suffers first of all) mean for the developing organism?!

If the fetus experiences oxygen deficiency in the late stages, this will affect the development of its various organs and systems. Such children may subsequently lag behind in mental and physical development and will often get sick.

Acute poisoning in the early stages in most cases ends in a miscarriage or a frozen pregnancy. The embryo is still very small at this stage, so any slightly overdose of nitrates will be poisonous to it. Moreover, nitrates promote rapid vasodilation, which makes them invaluable aids in arterial hypertension, but can harm the expectant mother by causing a miscarriage.

Nitrate poisoning is very dangerous for elderly people who have accumulated a large baggage of various diseases, including heart diseases, patients with low blood pressure, a predisposition to seizures, vitamin deficiency, neurological disorders, and respiratory diseases.

Forms

In principle, when nitrates and their harm to health are mentioned, many of us immediately think of watermelon and melon, and then greenhouse tomatoes and cucumbers. And although food products are far from the only source of nitrogen compounds, the most common reason for ending up in a hospital bed is food poisoning with nitrates.

Let's just say that not all of us work with nitrogen fertilizers, use nitrates in medicines or drink well water of questionable composition. But everyone wants to treat themselves to early or seasonal vegetables, fruits and berries. And sometimes it's so hard to resist treating your child to a piece of juicy watermelon or fragrant melon.

Nitrate poisoning from watermelon develops almost as quickly as from water. The first signs of nitrate poisoning in vegetables, such as gastrointestinal disorders and blue skin and mucous membranes, can appear within the first two hours. Such poisoning is usually severe, because watermelon is a large melon berry that can absorb the maximum amount of nitrates from water and soil.

In addition to watermelons, which can absorb up to 5 thousand mg of nitrogen salts per kilogram of weight, leaf lettuce, spinach, dill and onion greens, fodder, borscht and vinaigrette beets, leafy cabbage varieties and, of course, melons can boast a high nitrate content. It is clear that poisoning from melon and other products listed above can only be obtained if fertilizers with nitrates were added to the soil under them in abundance or water contaminated with nitrogen compounds was used for irrigation.

Carrots, cucumbers, radishes, zucchini and pumpkin, as well as white cabbage and cauliflower accumulate nitrates in smaller quantities (no more than 600 mg per kg). And the nitrate content in Brussels sprouts, legumes, potatoes, tomatoes, onions and garden berries is even lower. So, fresh cucumbers will be more dangerous on the New Year's table, and not tomatoes, as we are accustomed to thinking. But again, everything depends on the amount and time of application of fertilizers.

It should be said that soil fertilizers that cause accelerated plant growth and ripening of fruits require additional costs from the manufacturer, which subsequently affects the cost of off-season vegetables and greens. So people who do not want to spend a lot of money on something that will be sold in full and significantly cheaper after some time do not lose anything. It is unlikely that seasonal vegetables will be as heavily stuffed with nitrates as early ones, because no one wants to bear extra costs.

Among the group of products capable of absorbing the largest amount of nitrates, melons and gourds stand out. And this is not surprising, considering the portions we eat them in, as well as the fact that these products are not subjected to heat treatment, which, although not much, but reduces the content of nitrates. It is with poisoning from nitrate watermelons and melons that small children end up in hospital, whose parents could not help but respond to the pleading look and requests of their child.

Poisoning with nitrates and nitrites, formed from nitrates, most often occurs when eating fruits "fed" with fertilizers and drinking water contaminated with them. But the severity of poisoning in this case depends not so much on the amount of vegetables eaten or water drunk, but on the content of nitrogen compounds in them.

But the kitchen is far from the only place where poisoning can occur. A person can get it at work. For example, mercury nitrate is used to make glazes for ceramics, blacken brass, produce pyrotechnics, and in some chemical analyses. This substance is in the form of transparent crystals, soluble in water, and resembles salt or sugar in appearance. Nitrogen gives the compound a salty taste, so mercury nitrate poisoning can be caused by mistakenly taking it for a flavor additive.

Chemical poisoning with mercury compounds when inhaling vapors of the substance is similar to the symptoms of nitrate poisoning, but in this case the kidneys are usually severely affected, which, against the background of general hypoxia, does not give the most positive prognosis.

Pesticide and nitrate poisoning can occur in agricultural workers who work with fertilizers. By not observing hand hygiene and sitting down to eat with unwashed hands, they contribute to the saturation of the body with not only useful, but also harmful or downright toxic substances.

If the rules for storing plant nutrition and weed control products are not followed, far from harmless substances can enter the soil in large quantities, and from there penetrate deep into the groundwater, poisoning the soil and water for hundreds of kilometers. Animals and people will subsequently drink this water, which is fraught with intoxication.

People go to the hospital less often because of nitrate poisoning in water, because usually the concentration of nitrates in natural water is relatively low. However, there are cases described above that can significantly affect the statistics. Rural residents usually suffer from such carelessness, in whose wells the purest cold water, thanks to fertilized fields nearby, can be enriched with not the most useful mineral compounds and plant nutrition components that are harmful to people. Rural children also grow up on this water, and they can easily get poisoned, because for the symptoms of poisoning to appear in children, you do not need to drink so much nitrate water.

But don't think that city dwellers are protected from poisoning by nitrates contained in water. It is possible that nitrogen compounds can also end up in large bodies of water from which large cities receive their water (though there is hope that the problem will be quickly identified and eliminated).

You should also be careful when you find a spring with clear and seemingly pure water. If such a spring flows near agricultural fields or warehouses with fertilizers and pesticides, the composition of the water will probably not be as useful as we would like.

When we encounter nitrate poisoning in everyday life, we are mainly talking about nitrogen fertilizers used in agriculture: ammonium and sodium nitrate, nitrophoska and some other nitrates. When we eat out-of-season fresh cucumbers or watermelons and we have suspicious symptoms, we need to understand that this is poisoning not from the vegetables themselves, but from the nitrate with which they are stuffed above the norm.

In nitrate poisoning in medicines, we are dealing with other organic compounds of nitrous acid. Some of them (for example, nitroglycerin, which is a mixture of glycerin, nitrous and sulfuric acids) are explosives.

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Complications and consequences

No matter what exactly causes the poisoning, it never passes without a trace for a person, especially such a serious intoxication as nitrate poisoning. Perhaps nitrates themselves do not pose a particular danger and are not toxic substances, but the effect they have on the body conceals a hidden danger. In small doses it is unnoticeable, and in large doses it leads to the appearance of hypoxia symptoms.

Oxygen starvation of organs and tissues causes malfunctions. But it is always easier to cause functional disorders than to restore normal functioning of an organ or system. Most often, in case of severe poisoning, this requires serious treatment, which, however, does not guarantee that malfunctions will not recur in the future.

The situation is even more serious with nitrate poisoning of the fetus in the womb and small children, some of whose systems remain completely unformed even after the birth of the child. It is clear that any negative impact from the outside can affect the development of the child and the further work of vital organs.

Nitrate poisoning is quite difficult to bear even for generally healthy people, let alone those whose health is far from ideal. Hypoxia can cause complications of existing cardiovascular and liver diseases. In people with hypotension, nitrates can provoke an additional sharp decrease in blood pressure, which will lead to the development of a life-threatening condition called collapse. In case of respiratory diseases, symptoms of respiratory failure will appear very quickly, which will require urgent measures to save the patient's life. Neurological diseases can also become complicated against the background of hypoxia.

So even if you manage to quickly cope with the symptoms of poisoning, the consequences of severe and prolonged hypoxia can still remind you of themselves for a long time in the form of more and more new health problems.

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Diagnostics nitrate poisoning

Nitrate poisoning is the development of a condition in a person that requires emergency care. Do not think that everything will pass by itself by morning, you just need to drink the required number of activated charcoal tablets out of habit. But if symptoms of hypoxia appear, then charcoal will not help. It can cleanse the intestines, but not the blood, where nitrites have penetrated and developed their dangerous activity.

If symptoms of stomach upset and oxygen starvation appear, you can immediately suspect nitrate poisoning and call an ambulance. The longer the human body experiences hypoxia, the more severe the consequences will be. The doctor will need to be told what the patient ate and drank the day before, this will help determine the cause of the poisoning in order to provide emergency assistance.

At the hospital, medical staff will conduct the necessary tests. General and biochemical blood tests will show the presence of harmful substances and modified methemoglobin molecules. Quantitative analysis will help determine the severity of the poisoning and make some predictions regarding the treatment of the victim.

After emergency care has been provided and the patient's condition has stabilized somewhat, additional tests may be prescribed to help assess the extent of damage due to hypoxia of various organs and systems. Instrumental diagnostics may include an electrocardiogram, chest X-ray, brain tomography, kidney ultrasound, and other necessary tests depending on the symptoms indicating damage to a particular organ.

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Differential diagnosis

Despite the fact that delay in this case only aggravates the situation, it is important for the doctor to make an accurate diagnosis in order to prescribe the correct treatment. It is simply impossible to underestimate the role of differential diagnostics in this case, because the treatment of food poisoning with spoiled or infected products and nitrate poisoning have significant differences already at the stage of emergency care. In case of nitrate poisoning, an antidote is administered to save the patient's life, which is a solution of methylene blue. It neutralizes the harmful effects of nitrites formed when nitrates enter the body.

It is very important to pay attention not only to the patient's menu the day before the symptoms of stomach upset appear, but also to cyanosis or blueness of the skin and mucous membranes, shortness of breath, unusual weakness, etc., which helps to distinguish poisoning with stale food from hypoxia caused by nitrite intoxication and provide the necessary assistance in a timely manner.

It is especially difficult to diagnose nitrate poisoning in infants, because they do not show signs of food poisoning, and the symptoms are more reminiscent of toxic pneumonia, which occurs when particles of toxic substances are inhaled, causing inflammation of the bronchi and lungs.

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Treatment nitrate poisoning

In such a serious situation as poisoning with chemical compounds, which are nitrous acid salts, only a doctor in a hospital setting can provide the patient with qualified assistance to save his life. But this does not mean that until the ambulance arrives, you need to sit back and wait until the transformed nitrates turn half of the hemoglobin molecules into methemoglobin. You need to take measures as soon as possible to help slow down the penetration of nitrites into the blood. And for this, you need to know exactly what to do in case of nitrate poisoning.

Prevention

There is no need to refuse the gifts of nature. But it will be useful to observe some precautions. What can you do to protect yourself and your family from nitrate poisoning:

• If possible, it is better to grow vegetables and fruits in your own garden or dacha, or buy them from trusted producers. Old grannies and grandpas selling their own grown goods are unlikely to be carried away by buying chemical fertilizers. They will most likely feed the plants with humus or manure, which is not dangerous for the human body.
• Seasonal vegetables contain relatively low levels of nitrates, so they can only be dangerous by pure chance, if they accumulate nitrates from contaminated water or are planted near warehouses with nitrogen fertilizers. Seasonal vegetables can be bought without fear, but if you still have suspicions about them, you need to remember that:
  • the danger zone of potatoes is under the skin, as is the case with watermelons, cucumbers or melons,
  • in cabbage, nitrates accumulate in the stalk and upper leaves,
  • greens retain nitrogen compounds in the stems,
  • beets - in the pulp of the upper part of the root crop (1-2 cm) and tops,
  • carrots - also near the tops and in the core of the upper half of the plant.

By removing these parts of fruits and plants before consumption, you can significantly reduce the nitrate content in them.

• Heat treatment also reduces the nitrate content. At the same time, the amount of nitrates decreases not only in vegetables, but also in water. It turns out that by drinking boiled water, which, contrary to popular belief, is no less useful than raw water, and boiled vegetables, we can thereby protect ourselves from the sad consequences of nitrate poisoning. By the way, after boiling, vegetables should be immediately removed from the water, otherwise the boiled nitrates will return back to the fruit (this is the opinion of experienced doctors). It is also worth taking care that the boiled fruits cool down quickly.
• Not all vegetables can be boiled, and it is not always necessary. Raw vegetables and fruits retain more vitamins, which means they are more useful. You can reduce the amount of nitrates in raw vegetables by soaking them in water for a while.
• During storage, vegetables and fruits lose some of their nitrates and become less dangerous. But this cannot be said about natural juices made from them. Juices should be drunk freshly squeezed, beetroot juice is best left to stand for a couple of hours in the refrigerator.
• As for early vegetables, giving them up is unlikely to have a strong impact on your sense of joy in life, but it will help you save your health and money. Every vegetable has its time. It is clear that the wait for some of everyone's favorite melons may be delayed. They usually begin to ripen at the end of summer, in August, but you can see striped beauties of watermelons and fragrant yellow beauties of melons on the shelves of retail outlets much earlier. This is a great temptation, which is safer to fight. And if you are used to indulging your whims, then do it without the participation of children, for whom nitrate poisoning can have more serious consequences and a less rosy prognosis.

Greenhouse cucumbers and tomatoes, which are available on store shelves almost all year round, should also be treated with caution. Out of season, their quantity on the holiday table should be as limited as possible. It is better not to give such delicacies to children and pregnant women at all. The same applies to the elderly, who already have enough health problems.

• It is important to remember that nitrates are found not only in plants and water. They can be found in medicines belonging to the same group, or in sausages. Preparations from the nitrate group require special care in use, but a person with a heart condition cannot always refuse them. But bacon, bacon, sausage and other delicacies, the nitrate content of which can be judged by the color and information on the label or in the product documentation, can be completely abandoned in favor of products that were made without the use of harmful additives. Honestly, you can cook a delicious sausage at home, it will definitely not contain anything harmful or carcinogenic and is quite suitable for our children.
• When working with chemicals, nitrogen fertilizers, pesticides, you must strictly follow safety requirements, protecting your respiratory tract and exposed areas of the body from contact with dangerous "chemistry". There are special protective equipment for this, which you should use. Before lunch and after work, you must wash your face and hands with soap to remove nitrate particles from them, which can subsequently enter the digestive system.

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Forecast

The consequences of nitrate poisoning largely depend on the dose of nitrogen salts that have entered the body and the age of the victim. Both adults and children can equally eat the same watermelon or melon at the dinner table, but the smallest members of the family will suffer the most, because a microscopic dose of nitrites is enough to cause poisoning. The child immediately develops cyanosis of the skin and mucous membranes, lethargy, and a fever, while adults may get away with symptoms of dyspepsia or not react at all. In adults, nitrate poisoning from food products often occurs in a mild form, but the prognosis for nitrate poisoning in children is much worse.

In children, acute poisoning with nitrogen compounds more often than in adults occurs with the appearance of convulsions, shortness of breath and other consequences of oxygen starvation, which may not have the best effect on the child's development, or even lead to the death of the baby. Acute poisoning in an expectant mother can cause a miscarriage or the birth of a child with developmental delays and hereditary pathologies.

But it cannot be said that chronic poisoning passes without a trace. If the tissues of various organs and systems constantly experience a lack of oxygen, this will eventually lead to their weakening or atrophy and disruption of the organs. By regularly consuming products with a high nitrate content, we knowingly endanger our nervous system, heart, liver, kidneys and other organs experiencing moderate hypoxia.

Chronic nitrate poisoning turns into acute poisoning very rarely. For this to happen, a decent amount of nitrates must enter the body at one time, which will enhance the effect of the existing ones. But this does not mean that gradual poisoning of the body is less dangerous than immediate poisoning. Chronic nitrate poisoning should be understood as a slow death, when gradually, one by one, vital organs begin to fail.

Probably, reading these lines and discovering symptoms of chronic nitrate poisoning, many begin to think that nothing good can happen to them, because it is impossible to remove nitrates from the body. There is no need to despair. Chronic poisoning without the appearance of life-threatening symptoms is not so scary if you try to prevent the further entry of nitrogen salts into the body with food, water, as a result of your own carelessness when working with chemicals and fertilizers. Gradually, the balance of oxy- and methemoglobin will be restored, because blood is prone to renewal.

But how can one completely give up nitrates if a person does not have his own garden, and a complete refusal of plant products, in which these same nitrates are usually concentrated, will cause the body no less harm than poisoning with nitrogen compounds? After all, in this way we deprive the body of the opportunity to receive vitamins and minerals given by nature and so necessary for normal life.

We hear about nitrate poisoning almost every day, as soon as juicy, tempting early vegetables and greens appear on the shelves of retail outlets. Alas, despite the large number of such reports and the dangerous consequences of hypoxia caused by nitrites, people continue to spend big money on something that can even take their lives. But such is human nature. Until we ourselves encounter danger, we cannot fully believe in its existence.

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