title: Hydroxocobalamin treatment of acute cyanide poisoning from apricot kernels.
abstract: Clinical experience with hydroxocobalamin in acute cyanide poisoning via ingestion remains limited. This case concerns a 35-year-old mentally ill woman who consumed more than 20 apricot kernels. Published literature suggests each kernel would have contained cyanide concentrations ranging from 0.122 to 4.09 mg/g (average 2.92 mg/g). On arrival, the woman appeared asymptomatic with a raised pulse rate and slight metabolic acidosis. Forty minutes after admission (approximately 70 min postingestion), the patient experienced headache, nausea and dyspnoea, and was hypotensive, hypoxic and tachypnoeic. Following treatment with amyl nitrite and sodium thiosulphate, her methaemoglobin level was 10%. This prompted the administration of oxygen, which evoked a slight improvement in her vital signs. Hydroxocobalamin was then administered. After 24 h, she was completely asymptomatic with normalised blood pressure and other haemodynamic parameters. This case reinforces the safety and effectiveness of hydroxocobalamin in acute cyanide poisoning by ingestion.
authors.affiliation: UOS di Tossicologia Clinica, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. davide.cigolini@gmail.com
authors.forename: Davide
authors.initials: D
authors.lastname: Cigolini
authors.forename: Giogio
authors.initials: G
authors.lastname: Ricci
authors.forename: Massimo
authors.initials: M
authors.lastname: Zannoni
authors.forename: Rosalia
authors.initials: R
authors.lastname: Codogni
authors.forename: Manuela
authors.initials: M
authors.lastname: De Luca
authors.forename: Paola
authors.initials: P
authors.lastname: Perfetti
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Rocca
mesh_terms: D000208:Acute Disease; D000328:Adult; D005260:Female; D006397:Hematinics / Q000627:therapeutic use*; D006801:Humans; D006856:Hydrogen Cyanide / Q000506:poisoning*; D006879:Hydroxocobalamin / Q000627:therapeutic use*; D011041:Poisoning / Q000188:drug therapy / Q000209:etiology; D027861:Prunus / Q000506:poisoning*; D012639:Seeds / Q000506:poisoning; D016896:Treatment Outcome
chemical_list: D006397:Hematinics; D006856:Hydrogen Cyanide; D006879:Hydroxocobalamin