title: Severe cyanide poisoning from an alternative medicine treatment with amygdalin and apricot kernels in a 4-year-old child.
abstract: BACKGROUND
  The use of complementary and alternative medicine (CAM) is widespread in children with cancer and is poorly regulated.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  We describe a case of severe cyanide poisoning arising from CAM use. A severely agitated, encephalopathic, unresponsive 4-year-old boy (initial Glasgow Coma Scale of 3) with a history of metastatic ependymoma was brought to our emergency department by ambulance services. Initial blood gas analysis demonstrated severe metabolic/lactic acidosis. On detailed questioning of the parents, the use of CAM including intravenous and oral "vitamin B 17" (amygdalin) and oral apricot kernel was reported. After administering sodium thiosulfate, rapid improvement in his medical condition with complete recovery without need for further intensive care treatment was seen. Serum cyanide level was markedly elevated.
  
  
  CONCLUSIONS
  Cyanide poisoning can be the cause of severe encephalopathy in children receiving CAM treatment with substances containing cyanogenic glycosides.
authors.affiliation: Department of Pediatric Intensive Care Medicine, University Children's Hospital of Saarland, Building 9, 66421, Homburg, Germany, harald.sauer@uks.eu.
authors.forename: Harald
authors.initials: H
authors.lastname: Sauer
authors.forename: Caroline
authors.initials: C
authors.lastname: Wollny
authors.forename: Isabel
authors.initials: I
authors.lastname: Oster
authors.forename: Erol
authors.initials: E
authors.lastname: Tutdibi
authors.forename: Ludwig
authors.initials: L
authors.lastname: Gortner
authors.forename: Sven
authors.initials: S
authors.lastname: Gottschling
authors.forename: Sascha
authors.initials: S
authors.lastname: Meyer
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D000678:Amygdalin / Q000506:poisoning*; D001927:Brain Diseases / Q000139:chemically induced / Q000188:drug therapy; D001932:Brain Neoplasms / Q000188:drug therapy*; D002675:Child, Preschool; D000529:Complementary Therapies / Q000009:adverse effects*; D003486:Cyanides / Q000506:poisoning*; D004806:Ependymoma / Q000188:drug therapy*; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D009570:Nitriles / Q000506:poisoning*; D008517:Phytotherapy / Q000009:adverse effects*; D000068219:Prunus armeniaca / Q000506:poisoning*; D012639:Seeds / Q000506:poisoning*; D013885:Thiosulfates / Q000627:therapeutic use
chemical_list: D003486:Cyanides; D009570:Nitriles; D013885:Thiosulfates; C019063:prunasin; D000678:Amygdalin; C017717:sodium thiosulfate