众所周知,氰化物作为大规模杀伤性武器(ZyklonB气体-纳粹使用的氰化氢)已经为公众所知了一个多世纪,第一次世界大战期间的化学战代理人(氰化氢)和非常臭名昭著的“自杀药丸”,过去在第二次世界大战期间被军事和间谍组织使用(氰化钾)。在现代工业时代,氰化物中毒通常与工业暴露和家庭火灾有关。但人们对常见食物来源的氰化物中毒的潜在致命后果知之甚少。这里,我们提供了一例79岁女性因木薯叶制备不当而导致急性氰化物中毒的病例报告。摄入毒素的症状可能在暴露后几小时开始,其中包括头痛,混乱,共济失调,癫痫发作,心悸,恶心,呕吐,腹痛,冲洗,皮肤瘙痒。患者可能会出现低血压,心律失常,肾功能衰竭,肝坏死,横纹肌溶解症,和代谢性酸中毒;缺氧在细胞水平上的多系统表现。多种治疗策略可用于治疗氰化物中毒,包括亚硝酸钠,硫代硫酸钠,和羟基钴胺.这是一个完整的历史,了解导致氰化物毒性的药物和临床表现的知识可以帮助避免延误及时决策适当的治疗,从而降低发病率,死亡率,和延长的医院课程。
Cyanide is notoriously known to the public for more than a century now as a weapon of mass destruction (Zyklon B gas - hydrogen cyanide used by Nazis), an agent for chemical warfare during World War I (hydrogen cyanide) and very infamous \"Suicide Pill\" used in the past by military and espionage organizations during World War II (potassium cyanide). During the modern industrial era, cyanide poisoning is commonly associated with the industrial exposure and domestic fires. But there is little awareness about potentially fatal consequences of cyanide poisoning from common food sources. Here, we present the
case report of a 79-year-old female with acute cyanide poisoning from improperly prepared cassava leaves. Symptoms from ingested toxin may start a few hours after exposure, which include headache, confusion, ataxia, seizures, palpitations, nausea, vomiting, abdominal pain, flushing, and itching of the skin. Patients may develop hypotension, cardiac arrhythmias, renal failure, hepatic necrosis, rhabdomyolysis, and metabolic acidosis; a multisystem manifestation of hypoxia at the cellular level. Multiple treatment strategies are available to treat cyanide poisoning, including sodium nitrite, sodium thiosulfate, and hydroxycobalamine. This is one of the scenarios where a thorough history, awareness of agents causing cyanide toxicity and knowledge of clinical manifestations can help avoid delays in prompt decision-making for appropriate treatment, thus reducing morbidity, mortality, and prolonged hospital course.