Sodium Nitrite-Induced Methemoglobinemia in A Conflict Area: A Case Series from Sudan and Implications for Humanitarian Response

Background: With the ongoing conflict started in 2023, Sudan is facing one of the world's worst food crises and its healthcare system has been severely disrupted. Civilians increasingly rely on unsafe food sources, raising the risk of toxic exposures such as sodium nitrite ingestion, which can lead to life-threatening methemoglobinemia. Case Report: We describe a series of 15 individuals exposed to sodium nitrite, mistakenly used in place of table salt. One patient was dead on arrival; the others were diagnosed with methemoglobinemia and successfully treated with methylene blue or ascorbic acid. Food analysis confirmed high levels of sodium nitrite contamination. Why Should an Emergency Physician Be Aware of This?: In conflict settings, disrupted food supply chain and collapsed healthcare services can increase the risk of toxicological emergencies. This case series underscores how early recognition and access to essential treatments such as methylene blue are critical for successful management of methemoglobinemia. Beyond clinical care, understanding the context of the conflict and collaborating with local communities is essential to ensure appropriate and effective responses in challenging settings.