Cyanide Poisoning, 2 Cases Report and Treatment Review

SUW ANNA RUANGKANCHANASETR, M.D.*, SUBHAREE SUWANJUTHA, M.D.* VINAl WANANUKUL, M.D.**,

Affiliation : * Department of Pediatrics, ** Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.

AbstractTwo patients, a 4-year-old girl and her brother 1 1/ 2 year-old, with cyanide poisoning are reported. They vomited and became comatose 9 hours after ingestion of boiled cassava. At a community hospital, they were intubated and given ventilatory support. The girl was transferred to Ramathibodi Intensive Care Unit. At 19 hours after ingestion, sodium nitrite and sodium thio- sulfate were given as well as other supportive treatment. She recovered with normal breathing on the next day. The boy was referred to Ramathibodi 4 hours later. On arrival, he appeared normal except for the bitter almond breathe. Only supportive treatment was given. Their blood cyanide levels on arrival were 0.56 and 0.32 11g/ml (normal value < 0.3 11g/ml) respectively confirming the diagnosis of cyanide poisoning. Other abnormal laboratory findings included metabolic acidosis and lactic acidemia.
The pathogenesis and management of cyanide poisoning are reviewed.

Keywords : Cyanide Poisoning, Cassava Ingestion

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