Nitrite food poisoning from cold pork skin jelly: A report of two cases

Rationale: Nitrite, a common meat preservative, can cause life-threatening methemoglobinemia. Patient’s concern: Two men (52 and 60 years) developed sudden cyanosis, dizziness, and nausea 10-20 minutes after consuming pork skin jelly from a local deli. Diagnosis: Acquired methemoglobinemia (methemoglobin 50.7% and 37.2%); jelly contained 420 mg/kg nitrite (GB 2760-2014 limit: 30 mg/kg). Interventions: High-flow oxygen and intravenous 1% methylene blue 1-2 mg/kg in 20 mL 5% glucose over 15 minutes. Outcomes: Cyanosis was relieved within 30 minutes; methemoglobin became normalized within 2 hours. Both recovered fully and were discharged on June 24, 2024. Lessons: Sudden cyanosis after meat consumption requires immediate hospitalization, methemoglobin testing, and methylene blue treatment; food residue analysis confirms diagnosis, while supplier monitoring and record-keeping prevent recurrence.