Organic nitrates (eg, nitroglycerin, isosorbide dinitrate, and isosorbide mononitrate) are widely used as vasodilators for the treatment of ischemic heart disease and heart failure. Organic nitrates such as nitroglycerin also are used in explosives. Bismuth subnitrate, ammonium nitrate, and silver nitrate are used in antidiarrheal drugs, cold packs, and topical burn medications, respectively. Sodium and potassium nitrate and nitrite are used in preserving cured foods and may also occur in high concentrations in some well water. Butyl, amyl, ethyl, and isobutyl nitrites often are sold as “room deodorizers” or “liquid incense” and sometimes are inhaled for abuse purposes.

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   Mechanism of toxicity. Nitrates and nitrites both cause vasodilation, which can result in hypotension.

   
   
   
   
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      Nitrates relax veins at lower doses and arteries at higher doses. Nitrates may be converted into nitrites in the GI tract, especially in infants.

      
      
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      Nitrites are potent oxidizing agents. Oxidation of hemoglobin by nitrites may result in methemoglobinemia (See Methemoglobinemia), which hinders oxygen-carrying capacity and oxygen delivery. Many organic nitrites (eg, amyl nitrite and butyl nitrite) are volatile and may be inhaled.

   
   
   
   
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   Toxic dose.

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