Poisoning with nitrates and nitrites

Sometimes eating fresh food can encounter an unusual reaction on them of the gastrointestinal tract. It seems that everything was fresh on the table, but there are symptoms of poisoning. Most often, this happens in the spring and summer, as well as during the New Year holidays, when it is so difficult to deny yourself the off-season vegetables and fruits that beckon from the shelves. We buy them ourselves, give them to our children, and then we are genuinely surprised when the doctor diagnoses nitrate poisoning. But what is there to be surprised at, we did not know that all early vegetables and fruits are such due to nitrogenous fertilizers, i.e. Nitrates.

Nitrates: benefit and harm

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

But where do plants take nitrogen salts? Of course, in the soil and water, which we water them. Usually the soil contains enough nitrates, we get the harvest in time and are quite happy with it. If there are not enough nitrates, the plants turn out to be weak, do not give fruit, or their yield turns out to be very unsightly (the fruits are small, dry, irregular in shape). In this case, it is justified to add nitrogenous fertilizers to the soil, which we observe in agriculture.

True, every owner wants not only to have a good harvest, but also to get it before others to sell more expensive. Do this by increasing the dose of fertilizer. Especially important are fertilizers for plants grown in unnatural conditions, for example in greenhouses under artificial lighting. Without nitrates waiting for the fruit from them can be very long.

But the fruits obtained in this way will be dangerous for those who later use them, because they accumulate the bulk of nitrates. Nitrates are localized near the fetal rind, gradually breaking down during prolonged storage (vegetables lose 40 to 80% of nitrogen salts in half a year of storage and become less dangerous).

In small quantities, nitrates are always present in plants, because they participate in the construction of cellular structures. Just a small content of these substances is natural and does not harm the human body. Moreover, our body also contains nitrogenous salts, circulating with blood and taking part in the synthesis of protein and metabolism. The body itself produces them, but it is strictly regulated so as not to harm yourself.

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

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

It is difficult to imagine how many nitrates, in addition to their relatives, accumulate in our bodies. And after all, they are true, they accumulate, poisoning us, people who themselves gave them this opportunity. The use of a large amount of nitrogen salts by the vault and food products causes nitrate poisoning, when the symptoms of intoxication cause the consumption of seemingly fresh products.

But why do not plants die in this case. The thing is that they deal specifically with nitrates, which in themselves are not poisonous, but in our body, under the influence of saliva and certain enzymes, nitrates are able to turn into nitrites, considered to be quite toxic chemicals.

Causes of the poisoning with nitrates

The only cause of poisoning with nitrates, which are not poisonous substances, can only be their overdose. Like some other substances found in our body, nitrates do harm only in large doses. And an increase in the content of methaemoglobin (which we owe to nitrates converted to nitrites) is over 1% can already be considered an overdose, however, not dangerous.

According to the documents of the World Health Organization, no more than 3.7 mg of nitrate per kilogram of human body weight per day should enter the human body. Those. A person weighing 50 kg should receive not more than 185 mg with food, and if the body weight is 90 kg - not more than 333 mg. In this case, the content of nitrites 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 practice it often turns out that we use much more nitrates, and sometimes we do not understand what deterioration of our health is due to, until it becomes intolerable, 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 foods with an excessive content of nitrates and note unpleasant symptoms, such as headaches and weakness, but do not associate them with an overdose of nitrogenous compounds. But this until then, until it reaches a certain limit, and not only the brain, but also our other organs will begin to experience a noticeable oxygen starvation that will affect their work.

But an overdose of nitrates can be acute if a large amount of these substances has been ingested at a time. The risk factors for acute poisoning can be:

• the use of water from reservoirs, where wastes from fields fertilized with nitrates,
• work with nitrogenous fertilizers and the ingestion of them due to non-compliance with hand hygiene or by pure chance,
• the use of ready-made meat and sausage products with a beautiful pink shade, which is not due to dyes, but due to the use of nitrates as a preservative,
• treatment with medical preparations containing nitrates, for example, the same nitroglycerin.
• the use of the gifts of nature that we humans turned into poison in pursuit of large and early crops.

But let's see if all of the above points are equally dangerous. Let's start with the water. Is it likely that a person will drink water from a normal river or pond? Probably, it will be faster an exception. Faster such water will drink cattle, whose meat may later be on our table.

Some of the nitrates can also enter the groundwater, which supplies life-giving water to the water bodies used to produce drinking water. But the level of nitrates in drinking water is usually controlled, and hardly using it can get serious poisoning, except that nitrites will accumulate in the body for a long 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 have an excess of 10 and more times, so it is not surprising when nitrates poisoning the hospital with rural people. With acute symptoms, small children usually enter there, the organism of which does not yet produce enzymes capable of converting methemoglobin into hemoglobin. Poisoning as a result of drinking water in adults is infrequent.

When working with nitrogenous fertilizers, the risk of poisoning is great enough if you do not comply with safety regulations. It is also important to properly store chemical fertilizing for plants so that they are not 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, the stomach stops faster from overloading with shop meat dishes, than symptoms of nitrate poisoning will appear. We do not eat sausages and bacon in kilograms, which, perhaps, saves us from acute oxygen deficiency caused by intoxication with nitrogen salts. Nevertheless, the risk of chronic intoxication while abusing sausage products with nitrates is still high.

With medications, the story is somewhat different. "Nitroglycerin", "Isosorbide dinitrate", "Isosorbide mononitrate", "Isocardine", "Nitrogen" and other medicines containing organic nitrates, which are used for heart diseases, are used with extreme caution. A small excess of the dose immediately causes headaches and tachycardia, characteristic of mild hemoglobinemia.

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

Regrettably, it turns out that the main source of nitrates for humans are vegetables, fruits and berries. But if you consider that nitrogenous fertilizers are usually fed vegetables and melons, you can expect that it is in them the content of nitrates will be particularly high.

According to studies and statistics of poisoning, an increased amount of nitrates can be detected:

• in greenhouse vegetables (usually in cucumbers and tomatoes that fall on our table long before the soil is ripe)
• early greenery and the one that can be found fresh in stores on the eve of winter holidays (this is not the kind of greens that each of us could grow on a window sill without nitrates, but few practice it)
• root crops: potatoes, beets, carrots, radishes, radishes (for this reason it is not recommended to buy too large specimens that have become such because of nitrogenous fertilizing, because each producer tries to get a good harvest, but in what ways ?!)
• cabbage, which on unfertilized soil is obtained with small heads, or even without ovaries (natural fertilizers attract pests that damage the root of the plant, so it is easier to use chemical fertilizing, which scares off pests and yields a rich harvest)
• melons and watermelons.

But again, in most cases root crops are subjected to heat treatment, as a result of which a part of nitrates is destroyed. If the dish requires purified vegetables (and nitrates accumulate in the upper layers of the fruit), then part of the nitrogenous compounds leaves the skin in the trash.

With cabbage, we usually remove the top leaves, which can be dirty and damaged by various pests, and a cob, in which no less is nitrate, is thrown away (alas, not all and not always).

Remains green, the content of nitrates in which is relatively small, greenhouse vegetables and delicacies with melons. It must be said that our people treat greenhouse vegetables with great caution, knowing what they are stuffed with, so rarely such products get into the stomach for babies. Yes, and adults rarely abuse off-season vegetables, especially if you consider their high cost.

There are melons. In them, just lies the main danger. Poisoning with nitrates when you eat watermelon, which appeared on the table ahead of time, is considered almost a habit. And it's not surprising. Watermelon, especially early, is a fairly large berry, taking on a large number of nitrates. The cut watermelon is not kept for long, therefore the whole family has the opportunity to eat "from the belly" on the first day. But is not she going to be on a hospital bed afterwards? It depends on the "generosity" of the melon workers who feed the future harvest.

Usually watermelons and melons with nitrates appear shortly before the main mass of melon crops begins to sing. It is difficult for a person to understand whether there was any sense in feeding the plant with nitrates or ripeness 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. Fertilize the plants preferably before the beginning of fruiting, then the content of nitrates in vegetables will not be too high. But in pursuit of a good harvest, some unscrupulous farmers make fertilizers later, and their products subsequently become a poison for other people.

The weather is also playing a role. If the spring and summer do not please us on warm sunny days, plants are less able to absorb nitrates, which turn into proteins only under the influence of high temperatures. It turns out that fruits collected in cool wet years will have a greater content of unchanged nitrogenous compounds, overdose of which causes nitrate poisoning.

[1]

Pathogenesis

What do nitrites do? The pathogenesis of the organism's poisoning with nitrates is such that, when converted to nitrites and penetrating the blood, they bind to hemoglobin, and as a result of the reaction, methhemoglobin is formed. But if the usual hemoglobin in the lungs is enriched with oxygen, turning into oxyhemoglobin, and carries it around the body, providing cellular respiration, then methemoglobin is not able to attach oxygen molecules. He, like oxygenated hemoglobin, circulates in blood, but remains useless.

The more nitrates enter the body, the higher the probability of an increase in methaemoglobin, which should not be more than 1%, which is considered the norm. Since there are always nitrates in the body.

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

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

The body of an adult human can stand up for itself, converting by means of enzymes some part of methemoglobin into normal hemoglobin, thereby reducing the intensity of symptoms of intoxication. In the body of a small child, there are no reverse transformations, so children tolerate nitrate poisoning heavier than adults, and the percentage of deaths is higher, although there is no exact statistics on this. It is known only that the number of poisonings grows when early vegetables appear, as well as for holidays, because you want to decorate the festive table with off-season ripe cucumbers and tomatoes grown on nitrates in greenhouse conditions.

[2], [3]

Symptoms of the poisoning with nitrates

The organism of each person is individual, and the amount of nitrates that can get into the body can be significantly different. This leads to the fact that the symptoms of the disease in different people can have a different manifestation.

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

All these symptoms, which appear when the level of methemoglobin is more than 15% -20%, are very reminiscent of food poisoning provoked by stale or poor-quality food. But there are other symptoms specific for poisoning with nitrogenous salts:

• The skin of the victim's face becomes very pale with a noticeable blueness, which speaks of developing hypoxia. Especially striking cyanosis of the lips and nasolabial triangle. The tips of the fingers also turn blue, and the nails acquire an unusual blue tinge.
• But the whites of the eyes begin to turn yellow, which indicates a malfunction in the liver. This is confirmed by a feeling of heaviness and pain in the location of the organ.
• Among other things, a person feels an unusual weakness, quickly gets tired, it tends to sleep.

In the next stage, when the concentration of methemoglobin rises to 35-40%, the patient begins to complain of dizziness, headaches, tinnitus, he may have a fever and have problems with coordination of movements. There are malfunctions with the work of the cardiovascular and respiratory systems, which is manifested by shortness of breath, attacks of suffocation, tachycardia, lowering of arterial pressure, disturbances of the heart rhythm.

Further drowsiness can be replaced by increased excitement, a person has convulsions, episodes of loss of consciousness are possible. At a concentration of methaemoglobin in 45-50%, the patient may fall into a coma or die due to the failure of vital organs and systems.

If the poisoning with nitrates occurred through the fault of water, in which the content of nitrogenous compounds was inflated, the symptoms usually come earlier, after one hour. From the water, harmful substances enter the intestine and are absorbed more quickly than from food and medicine.

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 about poisoning with nitrates if after the meal there are no surprises. Food may not contain critical doses of nitrates, so acute poisoning does not occur. But the salts of nitrogen gradually accumulate in the body, and the useless methemoglobin formed by them supersedes the normal forms of hemoglobin, which bind oxygen molecules.

Over time, methemoglobin becomes more and more blood does not provide normal cellular respiration. From hypoxia, the brain and the nervous system suffer most of all, so a person begins to feel an incomprehensible weakness, he sometimes dizzy, chronic headaches may appear in the occipital part, work capacity worsens, and mood deteriorates. The disturbance of metabolism due to hypoxia leads to a shortage of useful vitamins and minerals in the body, a weakening of protective functions.

But such nonspecific symptoms are unlikely to lead to the thought of poisoning. A person with chronic nitrate poisoning usually consults a doctor at a stage when malfunctions in the work of various organs and systems begin.

All of the above applies to adults. But small children can suffer from nitrates. Parents themselves without knowing it can stuff the baby with nitrates, hidden:

• in milk mixtures, if water with a high content of nitrogen salts was used for their preparation,
• in vegetables, which are part of the complementary foods,
• in juices from vegetables and fruits grown in violation of the standards of nitrates in them, i.е. At an overdose of fertilizers.

Toddlers can simply swallow fertilizer, which in the form of small white grains will be found on the ground or in the shed by grandparents, taking them for food. Little babies are very curious and all try to taste. And even if the salty taste of nitrates is not to their taste, and the baby spits out a tasteless "candy", some of the substance will still fall into a fragile organism.

The poisoning of nitrates in children takes place according to a different scheme. Undesirable reactions from the gastrointestinal tract (vomiting and diarrhea) are usually not observed, which somewhat complicates the diagnosis. 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 CNS damage. It all begins with blue lips and a nail bed and reduces the mobility of the baby, which becomes apathetic, sluggish, sleeps a lot and is not played. Such symptoms appear even when the concentration of methaemoglobin in the blood in a child approaches 10%. Then there are shortness of breath, coordination of movements is disturbed, there is a convulsive syndrome.

Parents can note that the pen and legs of the baby are cold, and the liver is somewhat enlarged (you can identify palpation). These symptoms must always 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 how to protect itself from nitrites. So heavy poisoning by no-waste, life-threatening, in children is fixed when the percentage of methaemoglobin exceeds 30%.

No less dangerous is nitrate poisoning during pregnancy. During this period, the future 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. And what does the hypoxia of the brain (and he suffers in the first place) for the emerging organism?

If the fetus experiences oxygen deficiency in later terms, it will affect the development of its various organs and systems. Such children later can lag behind in mental and physical development, they will often get sick.

Acute poisoning in the early stages in most cases results in miscarriage or a frozen pregnancy. The embryo is still very small during this period, so any slightly inflated dose of nitrates will be a poison for it. Moreover, nitrates promote the rapid expansion of blood vessels, which makes them invaluable helpers in hypertension, but can harm a future mother by provoking a miscarriage.

It is very dangerous to poison nitrates to elderly people who have accumulated a lot of luggage of various diseases, including cardiac ones, to patients with low blood pressure, predisposition to convulsions, beriberi, neurological disorders, respiratory system diseases.

Forms

In principle, many of us, at the mention of nitrates and their harm to health, immediately come up with a watermelon and melon, and then already greenhouse tomatoes and cucumbers. And although food products are far from being the only source of nitrogen compounds, most often the reason for getting on a hospital bed is food poisoning with nitrates. 

Let's just say that not all of us work with nitrogenous fertilizers, use nitrates in medicines, or drink pollutant water from a well. But I want to pamper myself with early or seasonal vegetables, fruits and berries. And sometimes it's so difficult to resist not to buy a piece of juicy watermelon or a fragrant melon of your child.

Poisoning with nitrates when using watermelon  develops almost as quickly as from water. The first signs of poisoning with nitrates in vegetables, such as gastrointestinal disorders and blue skin and mucous membranes, may appear within the first two hours. Such poisoning usually proceeds hard, because the watermelon is a melon-growing large berry, capable of absorbing the maximum amount of nitrates from water and soil.

In addition to watermelons, able to absorb up to 5 thousand mg of nitrogenous salts per kilogram of weight, a large amount of nitrates can boast leaf lettuce, spinach, dill and onion greens, fodder, borscht and vinaigrette, cabbage and, of course, melons. It is clear that  poisoning from melons  and other products listed above can be obtained only if the soil under them was heavily fertilized with nitrates or used for irrigation contaminated with nitrogen compounds water.

Carrot, cucumber, radish, zucchini and pumpkin, as well as white cabbage and cauliflower accumulate nitrates in less quantity (not more than 600 mg per kg). And the content of nitrates in Brussels sprouts, beans, potatoes, tomatoes, onions and garden berries is even lower. So on the New Year's table, fresh cucumbers, not tomatoes, as we are accustomed to believe, will be more dangerous. But again everything depends on the amount and time of fertilizer application.

It should be noted that fertilizers for soil, which cause accelerated plant growth and fruit ripening, require additional costs from the producer, which further affects the cost of off-season vegetables and greens. So people who do not want to spend a lot of money on something that after a while will be sold in full and much cheaper, do not lose anything. It is unlikely that seasonal vegetables will also be heavily stuffed with nitrates, like the early ones, because no one wants to bear the extra costs.

Of the group of products that can absorb the greatest amount of nitrates, melons are especially prominent. And it's not surprising if we take into account what portions we eat, and also the fact that these products are not subjected to heat treatment, which, although not much, reduces the content of nitrates. It is with poisonings of nitrate watermelons and melons that young children enter the hospital, whose parents could not fail to respond to the pleading glance and requests of their child.

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

But the kitchen is not the only place where poisoning can happen. A person can get it in the workplace. For example, a compound such as mercury nitrate is used to make glazes coated with ceramics, brass, pyrotechnic products and some chemical analyzes. This substance in the form of transparent crystals, soluble in water and in appearance resembling salt or sugar. Nitrogen gives the compound a salty taste, so that  mercury poisoning with nitrate  can be obtained by mistaking it for a flavoring supplement.

The chemical poisoning by mercury compounds when inhaled vapors of the substance is similar to the symptoms of nitrate poisoning, but the kidneys usually suffer greatly, which, on the background of general hypoxia, does not give the most positive prognosis.

Poisoning by pesticides  and nitrates can be obtained by agricultural workers working with fertilizers. Not observing the hygiene of the hands and sitting down with unwashed hands to have a bite, they contribute to the saturation of the body not only useful, but also harmful or overtly poisonous substances.

If the rules of storage of funds for fertilizing plants and combating weeds are not respected, harmless substances can not reach the soil in large quantities, and from there they can penetrate deep into underground waters, poisoning soil and water for hundreds of kilometers. This water will later be consumed by animals and people, which is fraught with intoxication.

About poisoning with nitrates in water, people turn to the hospital less often, because usually the concentration of nitrates in natural water is relatively low. However, there are cases described above, which can significantly affect the statistics. From like carelessness usually suffer in the countryside, in the wells of which the cleanest cold water due to fertilized fields nearby can be enriched not by the most useful mineral compounds and components of plant nutrition harmful to humans. On the same water grow and rural children who can easily get intoxication, because for the appearance of symptoms of poisoning in children need to drink not much nitrate water.

But do not think that urban residents are protected from poisoning with nitrates contained in water. It is possible that the nitrogenous compounds can also enter large water bodies, from which large cities receive water (although there is a hope that the problem will be quickly identified and eliminated).

Caution should be observed and finding a spring with clear and, it would seem, the purest water. If such a spring flows not far from agricultural fields or warehouses with fertilizers and pesticides, the composition of the water will certainly not be as useful as we would like.

When we encounter nitrate poisoning in everyday life, we are talking mainly about nitrogen fertilizers used in agriculture: ammonium and sodium nitrate, nitrophos and some other nitrates. When we eat off-season fresh cucumbers or watermelons and we have suspicious symptoms, we must understand that this poisoning is not by the vegetables themselves, but by saltpetre, which they are stuffed in excess of the norm.

When poisoning with nitrates in the composition of drugs, we are dealing with other organic compounds of nitrous acid. Some of them (for example, nitroglycerin, a mixture of glycerin, nitrous and sulfuric acids) are explosives.

[4], [5]

Complications and consequences

No matter what the poisoning is caused, it never passes for a person without a trace, much less such a serious intoxication as nitrate poisoning. Perhaps, nitrates themselves do not represent a particular danger and are not toxic substances, but the effect they have on the body is fraught with a hidden danger. In small doses, it is invisible, and in large doses leads to the appearance of symptoms of hypoxia.

Oxygen starvation of organs and tissues causes a malfunction in their work. But it is always easier to cause a violation of functionality than to restore the normal operation of the organ or system. Most often with severe poisoning, this requires a serious treatment, which, however, does not guarantee that in the future failures will not be repeated.

Even more serious is the poisoning of fetal nitrates in the womb and small children, some of which even after birth are not completely formed. 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 tolerate even in general healthy people, and what can we say about those whose health is far from perfect. Hypoxia can cause complications of already existing cardiovascular and hepatic diseases. In people with hypotension, nitrates can provoke an additional sharp drop in blood pressure, which will lead to the development of a life-threatening condition called collapse. With respiratory diseases, the symptoms of respiratory failure very quickly appear, which will require urgent measures to save the patient's life. Against the background of hypoxia, neurological diseases can worsen.

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

[6], [7], [8], [9], [10], [11], [12], [13]

Diagnostics of the poisoning with nitrates

Nitrate poisoning is the appearance in a person of a condition requiring urgent care. Do not think that until morning everything goes by itself, you just need to drink the right amount of activated carbon tablets. But if there are symptoms of hypoxia, then coal will not help. He can cleanse the intestines, but not the blood where nitrite penetrated and developed their dangerous activity.

When symptoms of indigestion and oxygen deficiency appear, you can immediately suspect nitrate poisoning and call an ambulance. The longer a human body experiences hypoxia, the harder it will be for the consequences. The doctor will need to tell you what the patient ate and drank the day before, this will help determine the cause of the poisoning in order to provide emergency help.

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

After emergency help is provided and the patient's condition stabilizes slightly, additional tests can be assigned to him to help assess the degree of damage due to hypoxia of various organs and systems. Instrumental diagnostics may include a cardiogram, a chest X-ray, a brain tomogram, a kidney ultrasound and other necessary examinations, depending on the symptoms indicating damage to one or another organ.

[14], [15]

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 to prescribe the right treatment. To underestimate the role of differential diagnosis in this case is simply impossible, because the treatment of food poisoning with spoiled or infected foods and nitrate poisoning have significant differences already at the stage of emergency care. When poisoning with nitrates to save the patient's life, he is administered an antidote, 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 on the eve of the onset of symptoms of indigestion, but also to cyanosis or blueness of the skin and mucous membranes, dyspnea, unusual weakness, etc., which helps to distinguish poisoning from stale food from hypoxia caused by nitrite intoxication and timely necessary help.

It is especially difficult to diagnose nitrate poisoning in infants, because there are no signs of food poisoning, and the symptoms rather resemble the toxic pneumonia that occurs when inhaling particles of poisonous substances that cause inflammation of the bronchi and lungs.

[16], [17], [18], [19]

Treatment of the poisoning with nitrates

In such a serious situation as poisoning with chemical compounds, which are nitrous acid salts, only a doctor in a hospital can provide qualified assistance to a patient to save his life. But this does not mean at all that before the ambulance arrives, one should sit with folded arms and wait until the transformed nitrates convert half of the hemoglobin molecules into methemoglobin. It is necessary to take measures as soon as possible, which will help to slow the penetration of nitrites into the blood. And for this you need to know exactly  what to do with nitrate poisoning.

Prevention

It is not necessary to refuse the gifts of nature. But to observe some precautions will be helpful. What can be done to protect yourself and your family from poisoning with nitrates:

• If there is such an opportunity, it is better to grow vegetables and fruits in your own garden or dacha or buy them from trusted producers. Old grannies and grandfathers, selling self-grown goods, are unlikely to be addicted to buying chemical fertilizers. They are most likely to feed plants with humus or manure, which is not dangerous for the human body.
• In seasonal vegetables, the content of nitrates is relatively small, so they can be dangerous only by chance, if they accumulate nitrates from contaminated water or are planted near warehouses with nitrogenous fertilizers. Seasonal vegetables can be bought safely, but if you still have a suspicion about their account, you need to remember that:
  • the potato has a dangerous zone under the skin, however, like watermelons, cucumbers or melons,
  • in cabbage, nitrates accumulate in the stump and upper leaves,
  • greens retain nitrogen compounds in the stems,
  • beet - in the pulp of the upper part of the root crop (1-2 cm) and the tops,
  • carrots - also near the tops and in the core of the upper halves of the plant.

Removing before use these parts of fruits and plants can significantly reduce the content of nitrates in them.

• Reduces the nitrate content and heat treatment. At the same time, the amount of nitrates decreases not only in vegetables, but also in water. It turns out that using boiled water, which contrary to popular belief is no less useful than raw and boiled vegetables, we can thus protect ourselves from the sad consequences of nitrate poisoning. By the way, after cooking, vegetables should be immediately removed from the water, otherwise boiled nitrates will return back to the fetus (this is the opinion of experienced doctors). It is also worth taking care that the boiled fruit quickly cooled down.
• Not all vegetables can be boiled, and not always necessary. Raw vegetables and fruits retain more vitamins, which means they are more useful. Reduce the amount of nitrates in raw vegetables can be soaked them for a while in the water.
• In the process of storing vegetables and fruits, some of the nitrates lose and become less dangerous. But this can not be said about the natural juices from them. Juices need to be freshly squeezed, beet juice is best defended for a couple of hours in the refrigerator.
• As for the early vegetables, the rejection of them is unlikely to greatly affect the sense of joy of life, but it will help to preserve health and money. Each vegetable has its own time. It is clear that waiting for some of your favorite melons can drag on. They usually start singing at the end of the summer, in August, but on the shelves of shopping outlets you can see striped handsome watermelons and fragrant yellow-skinned beauties much earlier. This is a great temptation, which is safer to fight with. And if you are accustomed to indulging your whims, then do it without the participation of children, for whom poisoning with nitrates can have more severe consequences and a less than rosy forecast.

To greenhouse cucumbers and tomatoes, which are on store shelves almost all year round, also need to be treated with caution. Out of season, their quantity and festive table should be as limited as possible. Children and pregnant women should not give such goodies at all. The same goes for the elderly, who already have enough health problems.

• It must be remembered that nitrates are contained not only in plants and water. They can be found in medicines belonging to the same group, or sausages. Preparations from the group of nitrates require special care in the application, but to abandon them a person with a sick heart can not always. But from bacon, breasts, sausages and other delicacies, the content of nitrates in which you can judge by the color and information on the label or in the documents for the goods, it is possible to refuse in favor of products that were manufactured without the use of harmful additives. Honestly, delicious sausage can be cooked at home, it surely will not contain anything harmful and carcinogenic and is quite suitable for our children.
• When working with chemicals, nitrogenous fertilizers, pesticides, you must strictly observe the safety requirements, protecting your breathing paths and open areas of the body from contact with dangerous "chemistry". For this, there are special means of protection, which should be used. Before lunch and after work, you should definitely wash and wash your hands with soap to remove from them particles of nitrates, which can later get into the digestive system.

[20], [21]

Forecast

What will be the consequences of nitrate poisoning, largely depends on the dose of nitrogen salts that have got into the body, and the age of the victim. The same watermelon or melon at the dinner table can equally eat both adults and children, but most of all, the smallest members of the family will suffer, because to poison them with a microscopic dose of nitrites. The child immediately has cyanosis of the skin and mucus membranes, inhibition, the temperature can rise, while adults can get rid of the symptoms of dyspepsia or not react at all. In adults, nitrate poisoning from foods often occurs in mild form, but the forecast for nitrate poisoning in babies is much worse.

In children, acute poisoning with nitrogenous compounds more often than in adults, occurs with the appearance of convulsions, dyspnea and other effects of oxygen starvation, which may not have the best effect on the development of the child, or even lead to the death of the baby. Acute poisoning in a future mother can cause a miscarriage or birth of a child with developmental lag and hereditary pathologies.

But we can not say that chronic poisoning goes without a trace. If the tissues of various organs and systems are constantly lacking oxygen, this will eventually lead to their weakening or atrophy and disruption of the organs. By regularly eating foods high in nitrates, we consciously endanger our nervous system, heart, liver, kidneys and other organs experiencing mild hypoxia.

Chronic poisoning with nitrates becomes acute only rarely. For this, a decent amount of nitrates must be ingested in the body once, which will enhance the effect of the already available ones. But this does not mean that the gradual poisoning of the organism is less dangerous than the momentary one. Chronic nitrate poisoning should be understood as a slow death, when gradually one by one the vital organs begin to malfunction.

Probably reading these lines and discovering the symptoms of chronic nitrate poisoning, many people start to think that nothing good shines on them, because it is impossible to remove nitrates from the body. Do not despair. Chronic poisoning without the appearance of life-threatening symptoms is not so scary, if you try to prevent further intake of nitrogen salts 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 the blood is peculiar to be renewed.

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

About poisoning with nitrates, we hear almost every day, as soon as juicy, seductive 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 may even deprive them of their lives. But this is human nature. While we ourselves do not face the danger, we can not fully believe in its existence.

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