Acute cyanide poisoning and challenges in the diagnosis

Year 2024, Volume: 15 Issue: 53, 144 - 150, 05.12.2024

Çiğdem El , Mehmet Çelikkaya

Abstract

Objective: Cyanide that is known may be cause poisoning for centuries by mankind is a poison that can cause fatal intoxications in minutes, even in very small doses. It was aimed to emphasize the importance of acute cyanide poisoning that may occur by consuming apricot kernels containing amygdalin, a cyanogenic glycoside.
Method: Between September 2016 and October 2018, the data of the patients exposed to cyanide poisoning due to apricot seeds were examined retrospectively.
Results: The mean age of the patients was 39 months (23-65 months). Nine of the patients were female and 12 patients were male. Ten of all patients were native Turkish citizens and 11 of the patients were foreign national. It was learned that the patients ate an average of 15 pieces (10-30) of raw apricots kernel in their anamnesis. The complaints of the cases begin on average 45 minutes (30-90 minutes) after eating apricot seeds.
Conclusion: However acute cyanide poisoning is rare, it has a high potential for mortality when being suspected of cyanide poisoning based on the anamnesis and clinical features of the cases; should be supported immediately and specific treatment should be started.

Keywords

Amygdalin, apricot kernel, cyanide poisoning

Ethical Statement

Ethical permission was obtained from the Hatay Mustafa Kemal University, Medical Faculty Clinical Research Ethics Committee for this study with date 2018 and number 06, and Helsinki Declaration rules were followed to conduct this study.

References

• Hall AH, Dart R, Bogdan G. Sodium thiosulfate or hydroxocobalamin for the empiric treatment of cyanide poisoning? Annals of emergency medicine, 2007. 49(6): 806-813. https://doi.org/10.1016/j.annemergmed.2006.09.021
• Geller RJ, Barthold C, Saiers JA, Hall AH. Pediatric cyanide poisoning: causes, manifestations, management, and unmet needs. Pediatrics, 2006. 118(5): 2146-2158. https://doi.org/10.1542/peds.2006-1251
• Sauer H, Wollny C, Oster I, Tutdibi E, Gortner L, Gottschling S et al. Severe cyanide poisoning from an alternative medicine treatment with amygdalin and apricot kernels in a 4-year-old child. Wien Med Wochenschr, 2015. 165(9-10): 185-188. https://doi.org/10.1007/s10354-014-0340-7
• Senthilkumaran S, Menezes RG, Jayaraman S, Thirumalaikolundusubramanian P. Acute cyanide intoxication due to apricot seeds: is “evidence” countable? J Emerg Med, 2015. 48(1): p. 82-83. https://doi.org/10.1016/j.jemermed.2013.08.150
• Holzbecher MD, Moss MA, Ellenberger HA. The cyanide content of laetrile preparations, apricot, peach, and apple seeds. J Toxicol Clin Toxicol, 1984. 22(4): p. 341-347. https://doi.org/10.3109/15563658408992565
• Pentore R, Venneri A, Nichelli P. Accidental choke-cherry poisoning: early symptoms and neurological sequelae of an unusual case of cyanide intoxication. Ital J Neurol Sci, 1996. 17(3): p. 233-235. https://doi.org/10.1007/BF01995689
• Konstantatos A, Kumar MS, Burrell A, Smith J. An unusual presentation of chronic cyanide toxicity from self-prescribed apricot kernel extract. BMJ Case Rep, 2017:bcr-2017-220814. https://doi.org/10.1136/bcr-2017-220814
• Cigolini D, Ricci G, Zannoni M, Codogni R, De Luca M, Perfetti P et al. Hydroxocobalamin treatment of acute cyanide poisoning from apricot kernels. Emerg Med J, 2011. 28(9): p. 804-805. https://doi.org/10.1136/emj.03.2011.3932rep
• Beasley D, Glass W. Cyanide poisoning: pathophysiology and treatment recommendations. Occupational Medicine, 1998. 48(7): p. 427-431. https://doi.org/10.1093/occmed/48.7.427
• Kupper J, Schuman M, Wennig R, Gorber U, Mittelholzer A, Artho R et al. Cyanide poisoning associated with the feeding of apricot kernels to dairy cattle. Vet Rec, 2008. 162(15): p. 488-9. https://doi.org/10.1136/vr.162.15.488
• Hoffman RJ, Osterhoudt KC. Evaluation and management of pediatric poisonings. Pediatric case reviews, 2002. 2(1): p. 51-63. https://doi.org/10.1097/00132584-200201000-00007
• US Department of Health and Human Services. “Agency for Toxic Substances and Disease Registry: Toxicological profile for Lead (update) PB/99/166704.” Atlanta: US Department of Health and Human Services, 1999.