title: Disulfiram inhibition of cyanide formation after acetonitrile poisoning.
abstract: BACKGROUND
  Cyanide poisoning may be caused by acetonitrile, a common industrial organic solvent and laboratory agent.
  
  
  OBJECTIVE
  To describe the potential use of disulfiram in treating acetonitrile poisoning in a human clinical case and to further study its effect in human liver microsomes in vitro.
  
  
  METHODS
  A 30-year-old man initially presented with a cholinergic toxic syndrome following ingestion of aldicarb. Toxicological analysis revealed coingestion of ethanol. He subsequently developed severe metabolic acidosis caused by the cyanogenic compound acetonitrile which was erroneously interpreted as acetone in the chromatogram. After three treatments with hydroxocobalamin (5 g i.v.) and sodium thiosulfate (12.5 g i.v.) on days 2, 3, and 5, he had transient improvement but recurrent lactic acidosis. Treatment with disulfiram was associated on day 7 with resolution of metabolic acidosis and slowing of the decrease in acetonitrile concentration. He recovered from acetonitrile toxicity completely. The time course of acetonitrile, thiocyanate, and cyanide concentrations suggested that disulfiram inhibited cyanide formation.
  
  
  RESULTS
  In vitro experiments with human liver microsomes showed the cyanide concentration was significantly lower after incubation with acetonitrile and disulfiram than acetonitrile alone (a mean 60% reduction in cyanide level).
  
  
  CONCLUSIONS
  Although disulfiram was given late in the course of the poisoning it is possible that it contributed to the recovery.
authors.affiliation: a Department of Emergency Medicine , Ghent University Hospital , Ghent , Belgium.|b Heymans Institute of Pharmacology, Ghent University , Ghent , Belgium.
authors.forename: Peter
authors.initials: P
authors.lastname: De Paepe
authors.affiliation: c Laboratory of Medical Biochemistry and Clinical Analysis , Faculty of Pharmaceutical Sciences, Ghent University , Ghent , Belgium.
authors.forename: Pieter
authors.initials: P
authors.lastname: Colin
authors.affiliation: d Department of Intensive Care Medicine , Ghent University Hospital , Ghent , Belgium.
authors.forename: Pieter
authors.initials: P
authors.lastname: Depuydt
authors.affiliation: e Department of Clinical Chemistry , Microbiology and Immunology, Ghent University , Ghent , Belgium.
authors.forename: An-Sofie
authors.initials: AS
authors.lastname: Decavele
authors.affiliation: c Laboratory of Medical Biochemistry and Clinical Analysis , Faculty of Pharmaceutical Sciences, Ghent University , Ghent , Belgium.
authors.forename: Julie
authors.initials: J
authors.lastname: De Smet
authors.affiliation: c Laboratory of Medical Biochemistry and Clinical Analysis , Faculty of Pharmaceutical Sciences, Ghent University , Ghent , Belgium.
authors.forename: Koen
authors.initials: K
authors.lastname: Boussery
authors.affiliation: f Laboratory of Toxicology , Faculty of Pharmaceutical Sciences, Ghent University , Ghent , Belgium.
authors.forename: Christophe
authors.initials: C
authors.lastname: Stove
authors.affiliation: d Department of Intensive Care Medicine , Ghent University Hospital , Ghent , Belgium.
authors.forename: Dominique
authors.initials: D
authors.lastname: Benoit
authors.affiliation: e Department of Clinical Chemistry , Microbiology and Immunology, Ghent University , Ghent , Belgium.
authors.forename: Alain
authors.initials: A
authors.lastname: Verstraete
authors.affiliation: c Laboratory of Medical Biochemistry and Clinical Analysis , Faculty of Pharmaceutical Sciences, Ghent University , Ghent , Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Van Bocxlaer
authors.affiliation: a Department of Emergency Medicine , Ghent University Hospital , Ghent , Belgium.
authors.forename: Walter
authors.initials: W
authors.lastname: Buylaert
mesh_terms: D000097:Acetonitriles / Q000097:blood / Q000506:poisoning*; D000140:Acidosis, Lactic / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy*; D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects / Q000097:blood; D000448:Aldicarb / Q000097:blood / Q000506:poisoning; D015415:Biomarkers / Q000097:blood; D000067401:Blood Alcohol Content; D002800:Cholinesterase Inhibitors / Q000097:blood / Q000506:poisoning; D003486:Cyanides / Q000097:blood*; D004221:Disulfiram / Q000627:therapeutic use*; D000431:Ethanol / Q000009:adverse effects / Q000097:blood; D006801:Humans; D008297:Male; D008862:Microsomes, Liver / Q000187:drug effects / Q000378:metabolism; D011041:Poisoning / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000097:Acetonitriles; D015415:Biomarkers; D000067401:Blood Alcohol Content; D002800:Cholinesterase Inhibitors; D003486:Cyanides; D000431:Ethanol; D000448:Aldicarb; D004221:Disulfiram; C032159:acetonitrile
keywords: Acetonitrile; antidote; disulfiram; hydroxocobalamin; poison; sodium thiosulfate; toxicology