title: Acute self-induced poisoning with sodium ferrocyanide and methanol treated with plasmapheresis and continuous renal replacement therapy successfully: a case report.
abstract: Self-induced poisoning with chemicals is one of the most commonly used suicide methods. Suicide attempts using massive pure sodium ferrocyanide and methanol are rare. This article discusses the management of acute intentional self-poisoning using sodium ferrocyanide and methanol. We present a case of acute self-induced poisoning using sodium ferrocyanide and methanol admitted to our hospital 2 hours after ingestion. He was deeply unconscious and unresponsive to painful stimuli. The laboratory findings showed acute kidney injury and severe metabolic acidosis. We took effective measures including endotracheal intubation and mechanical ventilation to ensure the vital signs were stable. Subsequently, we treated the patient using gastric lavage, bicarbonate, ethanol, plasmapheresis (plasma exchange), and continuous renal replacement therapy (CRRT) successfully. He gradually recovered from poisoning and was discharged without abnormalities on the 6th day. Follow-up for 3 months revealed no sequelae. Blood purification including plasmapheresis and CRRT is an effective method to scavenge toxicants from the body for acute self-poisoning with sodium ferrocyanide and methanol. Treatment strategies in the management of poisoning, multiple factors including the removal efficiency of toxin, the protection of vital organs, and the maintenance of homeostasis must be considered.
authors.affiliation: From the Department of Emergency Medicine, Shengjing Hospital of China Medical University (ZL, HZ, MZ); and Pharmacy College, China Medical University, Shenyang, China (MS).
authors.forename: Zhenning
authors.initials: Z
authors.lastname: Liu
authors.forename: Mingli
authors.initials: M
authors.lastname: Sun
authors.forename: Hongyu
authors.initials: H
authors.lastname: Zhao
authors.forename: Min
authors.initials: M
authors.lastname: Zhao
mesh_terms: D000138:Acidosis / Q000139:chemically induced / Q000628:therapy; D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000628:therapy*; D000328:Adult; D005295:Ferrocyanides / Q000506:poisoning*; D005751:Gastric Lavage; D006801:Humans; D008297:Male; D000432:Methanol / Q000506:poisoning*; D010956:Plasmapheresis / Q000379:methods*; D017582:Renal Replacement Therapy / Q000379:methods*; D012121:Respiration, Artificial; D013406:Suicide, Attempted
chemical_list: D005295:Ferrocyanides; C020354:hexacyanoferrate II; D000432:Methanol