https://doi.org/10.4081/ecj.2020.8985

Severe lactic acidosis from acute cyanide poisoning after intentional amygdalin ingestion in a teenager

Vol. 16 No. 3 (2020)
Submitted: 26 March 2020
Accepted: 22 August 2020
Published: 23 December 2020
cyanide, suicidality, pediatrics
Abstract Views: 642
PDF: 298
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Jack Green
jack.green@cshs.org
Division of Pediatric Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States.

Cyanide poisoning via the oral route is a remarkably rare entity in the United States. Though acute toxicity from this poison may present with classic signs and symptoms (smell of bitter almonds on breath and cherry-red skin), these signs are frequently not clinically observed in the intoxicated patient, making it low on the routine differential diagnosis leading to both diagnostic and therapeutic challenges for the bedside clinician. This is a case of a 17-yearold male with a history of depression who presented to the Emergency Room (ER) with altered mental status, abdominal pain, and emesis. A severely elevated and worrisome lactic acidosis triggered the ER’s septic shock bundle and algorithm, but further investigation ultimately led to the unifying diagnosis of intentional cyanide poisoning.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
Hendry-Hofer TB, Ng PC, Witeof AE, et al. A review on ingested cyanide: risks, clinical presentation, diagnostics, and treatment challenges. Journal of Medical Toxicology 2019;15:128-33. DOI: https://doi.org/10.1007/s13181-018-0688-y
Ekinci F, Yildizdas D, Ates A, et al. Cyanide intoxication by apricot kernels: A case report and literature review. Emergency Care Journal 2019;15:75-8. https://doi.org/10.4081/ecj.2019.8256 DOI: https://doi.org/10.4081/ecj.2019.8256
Shragg TA, Albertson TE, Fisher CJ. Cyanide poisoning after bitter almond ingestion. West J Med 1982;136:65-9.
Ruangkanchanasetr S, Wananukul V, Suwanjutha, S. Cyanide poisoning, 2 cases report and treatment review. J Med Assoc Thai 1999;82:162-7.
Cressey P, Reeve J. Metabolism of cyanogenic glycosides: a review. Food and Chemical Toxicology 2019;125:225–32. DOI: https://doi.org/10.1016/j.fct.2019.01.002
Geller RJ, Barthold C, Saiers JA, et al. Pediatric cyanide poisoning: causes, manifestations, management, and unmet needs. Pediatrics 2006;118:2147-58. DOI: https://doi.org/10.1542/peds.2006-1251
Baud FJ, Haidar MK, Jouffroy R, et al. Determinants of lactic acidosis in acute cyanide poisonings. Critical Care Medicine 2018;46:523-9. DOI: https://doi.org/10.1097/CCM.0000000000003075
Borron SW, Baud FJ, Megarbane B, et al. Hydroxocobalamin for severe acute cyanide poisoning by ingestion or inhalation. Amer J Emerg Med 2007;25:551-8. DOI: https://doi.org/10.1016/j.ajem.2006.10.010
Gracia R, Shepherd G. Cyanide poisoning and its treatment. Pharmacotherapy 2004;24:1358‐65. DOI: https://doi.org/10.1592/phco.24.14.1358.43149
Cummings TF. The treatment of cyanide poisoning. Occup Med (Lond) 2004;54:82‐5. DOI: https://doi.org/10.1093/occmed/kqh020
Kann L, McManus T, Harris WA, et al. Youth risk behavior surveillance – United States, 2017. MMWR Surveill Summ 2018;67:100-14. DOI: https://doi.org/10.15585/mmwr.ss6708a1
Gummin DD, Mowry JB, Spyker DA, et al. 2018 Annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 36th annual report. Clinical Toxicology 2019;57:1220-1413. DOI: https://doi.org/10.1080/15563650.2019.1677022
Kappy MS, Morrow G. A diagnostic approach to metabolic acidosis in children. Pediatrics 1980;65:351-6. DOI: https://doi.org/10.1542/peds.65.2.351

How to Cite

Green, J. (2020). Severe lactic acidosis from acute cyanide poisoning after intentional amygdalin ingestion in a teenager. Emergency Care Journal, 16(3). https://doi.org/10.4081/ecj.2020.8985

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.