PT  - JOURNAL ARTICLE
AU  - Davide Cigolini
AU  - Giogio Ricci
AU  - Massimo Zannoni
AU  - Rosalia Codogni
AU  - Manuela De Luca
AU  - Paola Perfetti
AU  - Giampaolo Rocca
TI  - Hydroxocobalamin treatment of acute cyanide poisoning from apricot kernels
AID  - 10.1136/bcr.03.2011.3932
DP  - 2011 May 25
TA  - BMJ Case Reports
PG  - bcr0320113932
VI  - 2011
4099  - http://casereports.bmj.com/content/2011/bcr.03.2011.3932.short
4100  - http://casereports.bmj.com/content/2011/bcr.03.2011.3932.full
AB  - 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.