Life-threatening Torsades de Pointes resulting from "natural" cancer treatment.
BACKGROUND
Nonradioactive cesium chloride (CsCl) is used by some alternative medicine advocates as a treatment for cancer. The therapy was proven to be neither safe nor effective. Chronic use of CsCl has resulted in cases with severe cardiotoxicity.


METHODS
A 65-year-old lady presented to our hospital's accident and emergency department with recurrent syncope attacks. Electrocardiogram monitoring showed QT prolongation and transient Torsades de Pointes (TDP) ventricular tachycardia. She was taking anticancer naturopathic drugs for 6 weeks before admission. One of her naturopathic drugs was subsequently confirmed containing 89% CsCl by weight. Besides conventional treatment of QT prolongation and TDP, the patient was given a 4-week course of oral Prussian blue to enhance gastrointestinal elimination of cesium. The serum half-life of cesium was reduced from 61.7 to 29.4 days after the use of Prussian blue. QT prolongation was normalized in 27 days.


CONCLUSIONS
To our knowledge, this is the first published case of nonradioactive cesium poisoning treated with Prussian blue. A transient rise in serum cesium level was observed during Prussian blue therapy. Possible explanations for this observation include poor drug compliance during outpatient treatment and redistribution of cesium from body stores.


CONCLUSIONS
Nonradioactive CsCl poisoning can result in severe cardiotoxicity with QT prolongation and TDP ventricular tachycardia. The key points in the management of nonradioactive cesium poisoning include cessation of cesium exposure, vigorous electrolytes replacement, and oral Prussian blue therapy.
Chan
C K
CK
Hong Kong Poison Information Centre, United Christian Hospital, Kwun Tong, Hong Kong, China. chanck3@ha.org.hk
Chan
M H M
MH
Tse
M L
ML
Chan
I H S
IH
Cheung
R C K
RC
Lam
C W K
CW
Lau
F L
FL
D000368:Aged; D000931:Antidotes / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000506:poisoning*; D002586:Cesium / Q000506:poisoning*; D002712:Chlorides / Q000506:poisoning*; D000529:Complementary Therapies / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D004573:Electrolytes / Q000008:administration & dosage; D005260:Female; D005295:Ferrocyanides / Q000008:administration & dosage; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000473:pathology; D017180:Tachycardia, Ventricular / Q000139:chemically induced / Q000175:diagnosis / Q000628:therapy; D016171:Torsades de Pointes / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D016896:Treatment Outcome
D000931:Antidotes; D000970:Antineoplastic Agents; D002712:Chlorides; D004573:Electrolytes; D005295:Ferrocyanides; D002586:Cesium; C028019:cesium chloride; C000170:ferric ferrocyanide