Cyanide poisoning caused by ingestion of apricot seeds.
OBJECTIVE
To report diagnostic, clinical and therapeutic aspects of cyanide intoxication resulting from ingestion of cyanogenic glucoside-containing apricot seeds.


METHODS
Thirteen patients admitted to the Pediatric Intensive Care Unit (PICU) of Erciyes University between 2005 and 2009 with cyanide intoxication associated with ingestion of apricot seeds were reviewed retrospectively.


RESULTS
Of the 13 patients, four were male. The mean time of onset of symptoms was 60 minutes (range 20 minutes to 3 hours). On admission, all patients underwent gastric lavage and received activated charcoal. In addition to signs of mild poisoning related to cyanide intoxication, there was severe intoxication requiring mechanical ventilation (in four cases), hypotension (in two), coma (in two) and convulsions (in one). Metabolic acidosis (lactic acidosis) was detected in nine patients and these were treated with sodium bicarbonate. Hyperglycaemia occurred in nine patients and blood glucose levels normalised spontaneously in six but three required insulin therapy for 3-6 hours. Six patients received antidote treatment: high-dose hydroxocobalamin in four and two were treated with a cyanide antidote kit in addition to high-dose hydroxocobalamin. One patient required anticonvulsive therapy. All patients recovered and were discharged from the PICU within a mean (SD, range) 3.1 (1.7, 2-6) days.


CONCLUSIONS
Cyanide poisoning associated with ingestion of apricot seeds is an important poison in children, many of whom require intensive care.
Akyildiz
B N
BN
Department of Pediatric Intensive Care, Faculty of Medicine, Erciyes University, Kayseri, Turkey. basaknurbesra@gmail.com
Kurtoğlu
S
S
Kondolot
M
M
Tunç
A
A
D000138:Acidosis / Q000139:chemically induced / Q000188:drug therapy; D000931:Antidotes / Q000627:therapeutic use; D002606:Charcoal / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003128:Coma / Q000139:chemically induced; D003486:Cyanides / Q000633:toxicity*; D004435:Eating; D005260:Female; D005751:Gastric Lavage; D006397:Hematinics / Q000627:therapeutic use; D006801:Humans; D006879:Hydroxocobalamin / Q000627:therapeutic use; D006943:Hyperglycemia / Q000139:chemically induced; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D011041:Poisoning / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D027861:Prunus / Q000633:toxicity*; D012131:Respiratory Insufficiency / Q000139:chemically induced; D012189:Retrospective Studies; D012639:Seeds / Q000633:toxicity*; D012640:Seizures / Q000139:chemically induced; D017693:Sodium Bicarbonate / Q000627:therapeutic use; D014421:Turkey
D000931:Antidotes; D003486:Cyanides; D006397:Hematinics; D007328:Insulin; D002606:Charcoal; D017693:Sodium Bicarbonate; D006879:Hydroxocobalamin