Nitrates and nitrites can be categorized into inorganic and organic forms based on their chemical structure.
There are similarities and differences between these two chemical forms that affect their pharmacokinetic and pharmacodynamic properties and their subsequent biologic effects in humans. This artical will focus on inorganic nitrates.
Inorganic Nitrates and Nitrites
Inorganic nitrate (NO3–) and nitrite (NO2–) are water soluble (as a result of their interaction with the positively charged portions of polar water molecules)
and commonly exist as salts of nitric acid and nitrous acid, respectively. They are often bound to a metal cation such as Na+ or K+ and occur naturally through the fixation of atmospheric nitrogen and oxygen as part of the environmental nitrogen cycle (the cyclic movement of nitrogen in different chemical forms from the environment, to organisms, and then back to the environment as illustrated).
Inorganic nitrites are also produced endogenously through oxidation of nitrous oxide (NO) formed from the enzymatic degradation of L-arginine and through the reduction of nitrate with xanthine oxidoreductase.
Organic Nitrates and Nitrites
The organic forms of nitrates and nitrites are more complex and most are synthesized medicinal products (except ethyl nitrite). Organic nitrates are small non-polar hydrocarbon chains attached to a nitrooxy-radical (-ONO2; -ONO for amyl and ethyl nitrite). The addition of aliphatic or aromatic groups of variable length and volume affect the lipophilic properties of these molecules. It has been suggested that for some molecules, the greater the number of –ONO2 groups, the greater its potency; (the potency being dependent on the molecule’s lipophilicity).
- Nitrates and Nitrites exist in organic and inorganic
- The chemical form affects the pharmacokinetic and
pharmacodynamic properties of nitrates and
- Inorganic nitrates and nitrites are generally more
water soluble than organic nitrates and nitrates.
- Inorganic nitrates and nitrites are produced
endogenously and exogenously.
- Organic nitrates and nitrites are mostly synthesized
- Organic nitrates and nitrites are generally more
complex and lipophilic than inorganic nitrates and nitrites.
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Although a great way to disinfect CPAP masks and water chambers, the Lumin is not limited to disinfecting only CPAP items. Any non-living item which can fit inside the Lumin tray can be disinfected. This includes common items such as dentures, toothbrushes, hearing aids, small children toys and many more!
What can you put in the Lumin UVC?
|CPAP Mask||CPAP Tubing||Toys|
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The Multi-Purpose Disinfecting Machine
Do you like to have a weekend lie-in or a nightcap before going to bed? These habits could actually be harming your sleep.
Relax your mind
- Simple breathing exercises can help. Breathe, using your abdomen not your chest, through your nose for three seconds, then breathe out for three seconds. Pause for three seconds before breathing in again. Practise this for ten minutes at night (five minutes is better than nothing).
- Some people find that lavender oil, valerian or other herbs help them to sleep.
- If you still have problems, you could try massage, aromatherapy, or even acupuncture.
- If you still find yourself tossing and turning, abandon the bedroom and find something enjoyable and absorbing to do. Jigsaws are perfect. Don’t go back to bed until you begin to feel sleepy.
- Regular exercise is a great way to improve your sleep. Just be careful not to do it close to bed time as exercise produces stimulants that stop the brain from relaxing quickly.
- This being the case, exercising in the morning is an excellent way to wake up the body. Going for a run or doing some aerobics releases stimulants into the body, which perks you up.
- If you are injured or disabled, you can still benefit from exercise. Check out disability exercise tips.
Create a calm bedroom environment
- Your bedroom should be for sleep only. Avoid turning it into an entertainment centre with televisions, computers and stereos.
- Two thirds of children have a computer, games machine or TV in their bedroom and could be losing out on sleep as a result.
- It’s fine to have a nightcap, but too much alcohol can make you restless. Alcohol is also a diuretic, which means it encourages you to urinate (never welcomed during the night).
- Drinking is also more likely to lead to snoring, which can restrict airflow into the lungs. This reduces oxygen in your blood which disturbs your sleep and contributes to your hangover.
- Caffeine is a stimulant which can stay in your system for many hours. So avoid sources of caffeine such as coffee, chocolate, cola drinks and non-herbal teas.
Watch what you eat
- Eating a large heavy meal too close to bedtime will interfere with your sleep.
- Spicy or fatty foods may cause heartburn, which leads to difficulty in falling asleep and discomfort throughout the night.
- Foods containing tyramine (bacon, cheese, ham, aubergines, pepperoni, raspberries, avocado, nuts, soy sauce, red wine) might keep you awake at night. Tyramine causes the release of norepinephrine, a brain stimulant.
- If you get the munchies close to bedtime, eat something that triggers the hormone serotonin, which makes you sleepy. Carbohydrates such as bread or grain, cereal will do the trick.
Set a regular bedtime and wake up time
- Create a habit of going to bed and waking up at the same time each day, even on weekends. This helps anchor your body clock to these times. Resisting the urge for a lie-in can pay dividends in alertness.
- If you feel you haven’t slept well, resist the urge to sleep in longer than normal; getting up on schedule keeps your body in its normal wake-up routine.
- Remember, even after only four hours, the brain has gained many of the important benefits of sleep.
It’s only natural
- Most of us have a natural dip in alertness between 2 – 4pm.
- A 15 minute nap when you’re tired can be a very effective way of staying alert throughout the day. Avoid napping for longer than 20 minutes, after which you will enter deep sleep and feel even worse when you wake up.
See a doctor if your problem continues
If you have trouble falling asleep night after night, or if you always feel tired the next day, snore, or stop breathing during sleep you might have a sleep disorder. It is advisable to seek more advice from your doctor. Most sleep disorders can be treated effectively.
Sleep apnea is a common disorder that causes your breathing to stop or get very shallow. Breathing pauses can last from a few seconds to minutes. They may occur 30 times or more an hour.
Sleep apnea is the most common type of sleep disorder. It causes your airway to collapse or become blocked during sleep. Normal breathing starts again with a snort or choking sound. People with sleep apnea often snore loudly. However, not everyone who snores has sleep apnea.
You are more at risk for sleep apnea if you are overweight, male, or have a family history or small airways. Children with enlarged tonsils may also have it.
Doctors diagnose sleep apnea based on medical and family histories, a physical exam, and sleep study results.
A person may not be aware that his/her sleep is interrupted throughout the night due to snoring or obstructions. This is because he/she may not be fully conscious during these occurrences. However if a person feels drowsiness during the day, he/she should consult a doctor about getting a sleep study. People with sleep apnea are at higher risk for car crashes, work-related accidents, and other medical problems. If you have it, it is important to get treatment. Lifestyle changes, mouthpieces and surgery may help treat sleep apnea in many people if their diagnosis is mild. But if the diagnosis is moderate to severe, CPAP is the gold standard of treatment for optimal results.
The primary routes of exposure to nitrates and nitrites may differ depending on occupational and non occupational factors. Non-occupational factors may include:
- Hobbies (such as gardening, arc welding, etc.),
- History of inhalational drug use,
- Source of drinking/cooking water and how it is supplied,
- Outdoor activities,
- The chemical form of the nitrates and nitrites.
Occupational and Paraoccupational Exposures
Occupational exposure occurs primarily through the inhalation and dermal routes. Explosive and fertilizer industry workers may be exposed to nitrate through inhalation of dusts containing nitrate salts. Dusts can also dissolve in sweat exposing skin to concentrated solutions of the salts. Farmers may experience periodic exposures depending on their activities, especially with regard to the handling of fertilizers. Exposure of family members to nitrates from dusts brought home on work clothes has been reported.
The primary route of non-occupational exposure is ingestion of water or foodstuffs that contain high levels of nitrates or nitrites. Inhalation exposures may occur from inhalant drug use and dermal exposures may occur from some topical medications. These would be special instances and not the primary routes of exposure for the general population.
- Primary occupational routes of exposure to nitrates and nitrites include inhalation and dermal routes.
- The primary route of exposure to nitrates and nitrites for the general population is ingestion.
- Inhalation and dermal exposures have been reported in non-occupational settings under certain circumstances, but are not the primary routes of exposure for the general population.
Understanding the environmental fate of nitrates and nitrites may help pinpoint potential sources of exposure. This would be important in assessment of patient exposure risk, prevention and mitigation of nitrate / nitrite overexposure and in the prevention of adverse health effects from exposure.
Environmental Nitrogen Cycle
In general, the following describes the activity of nitrates and nitrites in the environment. Microbial action in soil or water decomposes wastes containing organic nitrogen into ammonia, which is then oxidized to nitrite and nitrate.
- Because nitrite is easily oxidized to nitrate, nitrate is the compound predominantly found in groundwater and surface waters.
- Contamination with nitrogen-containing fertilizers (e.g. potassium nitrate and ammonium nitrate), or animal or human organic wastes, can raise the concentration of nitrate in water.
- Nitrate-containing compounds in the soil are generally water soluble and readily migrate with groundwater.
Shallow, rural domestic wells are those most likely to be contaminated with nitrates, especially in areas where nitrogen-based fertilizers are widely used.
- Approximately 15 percent of Americans rely on their own private drinking water supplies which are not subject to U.S. Environmental Protection Agency (EPA) standards, although some state and local governments do set guidelines to protect users of these wells.
- In agricultural areas, nitrogen-based fertilizers are a major source of contamination for shallow groundwater aquifers that provide drinking water.
- A recent United States Geological Survey study showed that 7 percent of 2,388 domestic wells and about 3 percent of 384 public-supply wells nationwide were contaminated with nitrate levels above the EPA drinking water standard of 10 parts per million (ppm) or 10 mg/L.
- Elevated concentrations were most common in domestic wells that were shallow (less than 100 feet deep) and located in agricultural areas because of relatively large nitrogen sources, including septic systems, fertilizer use, and livestock.
- Although suppliers of public water sources are required to monitor nitrate concentrations regularly, few private rural wells are routinely tested for nitrates.
- During spring melt or drought conditions, both domestic wells and public water systems using surface water can show increased nitrate levels.
- Drinking water contaminated by boiler fluid additives may also contain increased levels of nitrites.
- Mixtures of nitrates / nitrites with other well contaminants such as pesticides and VOCs have been reported.
Nitrate and nitrite overexposure has been reported via
ingestion of foods containing high levels of nitrates and nitrites. Inorganic nitrates and nitrites present in contaminated soil and water can be taken up by plants, especially green leafy vegetables and beet root.
- Contaminated foodstuffs, prepared baby foods, and sausage / meats preserved with nitrates and nitrites have caused overexposure in children.
- Although vegetables are seldom a source of acute toxicity in adults, they account for about 80% of the nitrates in a typical human diet.
- Celery, spinach lettuce, red beetroot and other vegetables have naturally greater nitrate content than other plant foods do.
- The remainder of the nitrate in a typical diet comes from drinking water (about 21%) and from meat and meat products (about 6%) in which sodium nitrate is used as a preservative and color- enhancing agent.
- For infants who are bottle-fed, however, the major source of nitrate exposure is from contaminated drinking water used to dilute formula.
- Bottled water is regulated by the U.S. Food and Drug Administration (FDA) as a food. It is monitored for nitrates, nitrites and total nitrates / nitrites.
Nitrate Content of Selected Vegetables
|Vegetable||Nitrate content, mg / 100g fresh weight|
|Celery, lettuce, red beetroot, spinach||Very High (> 2500)|
|Parsley, leek, endive, Chinese cabbage, fennel||High (100-250)|
|Cabbage, dill, turnip||Medium (50-100)|
|Broccoli, carrot, cauliflower, cucumber, pumpkin||Low (20-50)|
|Artichoke, asparagus, eggplant, garlic, onion, green bean, mushroom, pea, pepper, potato, summer squash, sweet potato, tomato, watermelon||Very Low (<20)|
Other Sources of Exposure
Nitrate or nitrite exposure can occur from certain medications and volatile nitrite inhalants.
Accidental and inadvertent exposures to nitrites as well as ingestion in suicide attempts have been reported.
Deliberate abuse of volatile nitrites (amyl, butyl, and isobutyl nitrites) frequently occurs. Amyl nitrite (nicknamed by some as “poppers”) is used commercially as a vasodilator and butyl / isobutyl nitrites can be found in products such as room air fresheners.
Fatalities have been reported in adults exposed to nitrates in burn therapy; however infants and children are especially susceptible to adverse health effects from exposure to topical silver nitrate used in burn therapy.
Other medications implicated in methemoglobinemia include:
- Quinone derivatives (antimalarials),
- Bismuth subnitrite (antidiarrheal),
- Ammonium nitrate (diuretic),
- Amyl and sodium nitrites (antidotes for cyanide and hydrogen sulfide poisoning),
- Isosorbide dinitrate/tetranitrates (vasodilators used in coronary artery disease therapy),
- Benzocaine (local anesthetic), and
- Dapsone (antibiotic).
Other possible sources of exposure include ammonium nitrate found in cold packs and nitrous gases used in arc welding.
An ethyl nitrite folk remedy called “sweet spirits of nitre” has caused fatalities.
- Shallow, rural domestic wells are those most likely to be contaminated with nitrates, especially in areas where nitrogen based fertilizers are in widespread use.
- Other nitrate sources in well water include seepage from septic sewer systems and animal wastes.
- Foodstuffs high in nitrates, home prepared baby foods, and sausage/meats preserved with nitrates and nitrites have caused overexposure in children.
- Nitrate or nitrite exposure can occur from certain medications and volatile nitrite inhalants.
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Lumin UVC – Disinfection & Cleaning
What is Lumin UVC?
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DISINFECTION – Cleaning
Quick 5 Min cleaning – Interface Disinfection
Lumin UVC works by emitting high energy light within a narrow spectrum referred to as UV-C. The device relies on a low-pressure, mercury-arc germicidal lamp designed to produce the highest amounts of UV light – where 90% of energy is generated around 254nm. Especially the dose of UV-C emitted in one 5-minute cycle is sufficient to kill most bacteria and mold on a surface.
UV Light kills 99% of Bacteria
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No Harmful Ozone
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Mask: Remove the mask / nasal pillows from the headgear. Clean with warm, soapy water. Rinse;
Tubing: Wash in warm soapy water, then rinse and air dry;
Humidifier: Empty the humidifier and let it air dry. Change the water in the humidifier.