Date: Mon, 26 Oct 2009 09:59:02 -0600
Reply-To: DCHAS-L Discussion List <DCHAS-L**At_Symbol_Here**LIST.UVM.EDU>
Sender: DCHAS-L Discussion List <DCHAS-L**At_Symbol_Here**LIST.UVM.EDU>
From: Alan Hall <ahalltoxic**At_Symbol_Here**MSN.COM>
Subject: Re: Harvard Tightening Security After 6 Poisoned Students,
Researchers Ingest Lethal Chemical
In-Reply-To: <D2712CBC-D97E-49E3-895E-CFAF93524201**At_Symbol_Here**>

You might check my Chapter in the most recent version of Hadd ad and Winchester's Clinical Management of Poisoning and Drug Overdose, 4 th ed.  Hall, AH:  Cyanide and Related Compounds -- Sodium Azide.  Shannon MH et al (eds), Haddad and Winchester's Clinical M anagement of Poisoning and Drug Overdose, 4th ed., Saunders Else vier, 2007, pp. 1309-1316.
Solutions of sodium azide are indeed colorless, odorless, and ta stless laboratory solutions, which can and have been mistaken for water o r normal saline and inadvertantly ingested when usual laboratory safety pre cautions have not been followed.  Clearly, using anything r esembling water in coffee or tea making in laboratories, especially anyth ing in laboratory glassware, must be prohibited.  Suicidal or homi cidal exposure cannot be ruled out as both have happened.  Indeed, there are very few cases of azide poisoning in the world medical li terture.  At the time of the above review, between 1927-1999, th ere were only 38 publications regarding sodium azide poisoning found with o nly 69 actual poisoning cases.  Hypotension is the most common clini cal effect, which usually occurs within minutes to 1 hour after ingestion exposure.
While the mehanisms of toxic action in azide poisoning is quite similar to that of cyanide, all studies to date indicate that cyanide antidotes are not efficacious in azide poisoning.  There are some perhaps interest eing rat mitochondria in vitro studies with hydroxocobalamin, but this re mains essentially theoretical at this time. 
We will be discussing sodium azide/hydroazoic acid poisoning in an upcoming revision of the appropriate chapter in Irwin and Rippe's Intensive Care Me dicine, 7th edition (revision in progress).
Alan H. Hall, M.D.
Medical Toxicologist
Toxicology Consulting and Medical Translating Services, Inc.
Laramie, WY
Colorado School of Public Health
Denver, CO

> Date: Mon, 26 Oct 2009 11:13:22 -0400
> Fr om: ecgrants**At_Symbol_Here**UVM.EDU
> Subject: [DCHAS-L] Harvard Tightening Securi ty After 6 Poisoned Students, Researchers Ingest Lethal Chemical
> ; To: DCHAS-L**At_Symbol_Here**LIST.UVM.EDU
> http://www.thebostonchann
> Harvard Tightenin g Security After 6 Poisoned Students, Researchers
> Ingest Letha l Chemical
> BOSTON -- Harvard University Medical School will increase security and
> install new video cameras at its lab oratories this week as police work
> to determine whether six peop le were intentionally poisoned at a
> research building.
> The scientists and students fell ill on Aug. 26 after consuming a
> potentially lethal chemical that was present in their coffee ,
> according to an internal memo sent to medical school student s on Friday.
> All six people had used a single-serve co ffee machine near their
> pathology lab at Harvard=92s New Researc h Building to prepare the
> coffee, and all later reported dizzi ness and low blood pressure.
> Testing revealed the pres ence of sodium azide, a common preservative,
> in the coffee , the memo said. Sodium azide is an odorless white solid,
> ac cording to the Centers for Disease Control Web site.
> O ne person became unconscious. All six were taken to Beth Israel
> Deaconess Medical Center for treatment. None suffered long-term
> consequences from the poisoning.
> The university said i t does not know if the poisoning was deliberate
> or accidental.>
> =93While we do not yet know how the incident occurred , we have recently
> learned that sodium azide ... was present i n the coffee consumed by
> the six employees,=94 the memo reads.
> Many workers and students who frequent the building s aid they had not
> yet heard about the incident.
> ; "I'm actually kind of surprised," one said.
> Swal lowing the chemical can cause rapid breathing, dizziness and
> n ausea, according to the CDC.
> The federal Occupationa l Safety and Health Administration and the
> Boston Public Health Commission are investigating.
> =93We are in the process of installing additional security cameras
> throughout our buildi ngs, and we are strengthening the security
> systems that manage access to the laboratories during both normal
> business hours an d off hours,=94 the Harvard memo said.
> Copyright 200 9 by All rights reserved. This
> material ma y not be published, broadcast, rewritten or redistributed.
> >
> ===
> http://news.bostonherald .com/news/regional/view/20091026experts_discount_accident_theory_in_harvard _coffee_poisoning/srvc=home&position=2
> Exper ts discount =91accident=92 theory in Harvard coffee poisoning
> By Adam Smith and Jessica Van Sack
> Buzz up!
> A leading toxicologist believes the chances are slim that six lab < BR>> workers at Harvard University Medical School were poisoned by acc ident.
> =93An accident? Sodium azide is a poison,=94 said David M. Benjamin, a
> toxicologist and Chestnut Hill-based clinical pharmacologist.
> =93Absolutely not.=94
&g t; The Herald reported yesterday that six scientists and students at the
> New Research Building in Boston=92s Longwood Medical area were < BR>> mysteriously poisoned after drinking from a communal, single-se rve
> coffee machine on the eighth floor near their pathology lab on Aug.
> 26. Seconds later all six reported symptoms including di zziness and
> low blood pressure and were taken to Beth Israel Dea coness Medical
> Center for treatment.
> =93Cou ld it have gotten in the coffee machine inadvertantly? Absolutely
> ; not,=94 Benjamin said of the compound, an odorless white solid used in
> labs as a preservative. =93It could be considered an attempt ed murder or
> assault.=94
> Harvard did not ma ke the poisoning public until after repeated
> inquiries from the Herald. The university continued to skirt questions
> yesterday, with a spokesman referring inquiries to Harvard police, and
> t he police referring questions back to the spokesman.
> =93This is crazy,=94 said a Harvard Medical School researcher who did not
> want to be identified. =93I don=92t know why it would take two months to
> announce this.=94
> Although he is not privy to the investigation, medical school
> spokesman David Cameron said, =93What I know at this point in time is
> that al l options and potential avenues for how this could have
> happened are being very thoroughly and intensely investigated.=94
> ; The same substance was used in a string of coffee and tea poisoning
> incidents in Japan a decade ago. In one incident, the chief inter nist
> of a Kyoto hospital was found guilty of lacing the green te a ingested
> by seven fellow doctors with sodium azide.

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