Severe suicidal self-poisoning with massive dose of potassium ferricyanide(III): hyperkalemia but not free cyanide may cause death
Potassium ferricyanide(III), K3[Fe(CN)6], has a widespread use in blueprint drawing, photography, chemical industry, and metallurgy. In mice, the oral lethal dose 50 (LD50) is 1600 mg kg−1. We report the case of a suicide attempt in a 37-year-old male by intentional ingestion of 80 g of potassium ferricyanide(III) dissolved in water. The estimated ingested dose was 770 mg kg−1. The patient reported vertigo as the first sign of poisoning and six episodes of diarrhea with dark-colored stool 2 h after ingestion. The patient was transported by ambulance to the intensive care unit 8 h after ingestion. He was conscious and spontaneously ventilating, with a Glasgow Coma Scale (GCS) score of 15. On ECG performed at admission, tall “tented” T waves in V3–V6 and progressive flattering of P waves were registered. Serum concentrations of potassium of 7.2 mmol dm−3, urea of 7.1 mmol dm−3, and creatinine of 162 µmol dm−3 indicated development of acute renal failure. Despite the administration of intravenous insulin and 10% glucose infusion during the first hours after admission, there was a further elevation of serum potassium to 7.4 mmol dm−3 suggesting acute renal failure. For this reason, intermittent hemodialysis was performed [duration 200 min, blood flow rate 147 cm3 min−1, online clearance monitoring (OCM) clearance rate 100 cm3 min−1, and substitution fluid volume 5.8 dm3]. The condition of the patient stabilized and he was discharged from hospital on the fourth day after admission. This case report demonstrates the risks of life-threatening hyperkalemia and acute renal failure as complications of massive ingestion of potassium ferricyanide(III).
KeywordsPotassium ferricyanide(III) Intoxication Hyperkalemia Acute renal failure
The research was supported by the Ministry of Health of the Czech Republic (AZV) by the Grants nos. 16-27075A and 44/18D, by the Projects PROGRES Q25 and Q29 of the First Faculty of Medicine, Charles University in Prague, and research of T.N. was supported by the Czech Science Foundation (Project GA ČR no. 17-03868S).
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