Citation

Coentrão L, Moura D. Am. J. Emerg. Med. 2011; 29(1): 78-81.

Affiliation

Faculty of Medicine, Institute of Pharmacology and Therapeutics, University of Porto, Porto 4200-319, Portugal; Nephrology Research and Development Unit, Faculty of Medicine, University of Porto, Hospital de S. João EPE, Porto 4200-319, Portugal.

Copyright

(Copyright © 2011, Elsevier Publishing)

DOI

10.1016/j.ajem.2009.09.014

PMID

20825788

Abstract

Limited work has focused on occupational exposures that may increase the risk of cyanide poisoning by ingestion. A retrospective chart review of all admissions for acute cyanide poisoning by ingestion for the years 1988 to 2008 was conducted in a tertiary university hospital serving the largest population in the country working in jewelry and textile facilities. Of the 9 patients admitted to the hospital during the study period, 8 (7 males, 1 female; age 36 ± 11 years, mean ± SD) attempted suicide by ingestion of potassium cyanide used in their profession as goldsmiths or textile industry workers. Five patients had severe neurologic impairment and severe metabolic acidosis (pH 7.02 ± 0.08, mean ± SD) with high anion gap (23 ± 4 mmol/L, mean ± SD). Of the 5 severely intoxicated patients, 3 received antidote therapy (sodium thiosulfate or hydroxocobalamin) and resumed full consciousness in less than 8 hours. All patients survived without major sequelae. Cyanide intoxication by ingestion in our patients was mainly suicidal and occurred in specific jobs where potassium cyanide is used. Metabolic acidosis with high anion is a good surrogated marker of severe cyanide poisoning. Sodium thiosulfate and hydroxocobalamin are both safe and effective antidotes.

Language: en