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Manifestations cardiovasculaires de l’intoxication cyanhydrique aiguë

Cardiac disorders of cyanide intoxication

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Annales françaises de médecine d'urgence

Résumé

Longtemps méconnue, l’intoxication cyanhydrique survient le plus souvent lors d’inhalation accidentelle de fumées d’incendie. Au niveau cellulaire, le cyanure se fixe en inhibant le cytochrome oxydase mitochondrial, ce qui entraîne un arrêt de la consommation d’oxygène avec déviation du métabolisme vers un mode anaérobie. À côté des signes cliniques respiratoires et neurologiques classiques, l’épidémiologie des manifestations cardiovasculaires est peu documentée. Si l’arrêt cardiorespiratoire et l’hypotension sont rapidement identifiés, d’autres signes cardiaques doivent être reconnus comme les troubles du rythme, de la conduction et de la repolarisation, notamment chez les patients intoxiqués à faibles doses. La réalisation d’un électrocardiogramme est donc systématique. Compte tenu de sa gravité potentielle, le traitement spécifique de l’intoxication cyanhydrique aiguë doit être instauré sans délai, immédiatement après la reconnaissance de la symptomatologie. L’hydroxocobalamine représente l’antidote de première intention en médecine d’urgence. Son administration se réalise par voie intraveineuse à la posologie moyenne de 5 g, qui peut être répétée, voire de 10 g d’emblée en cas d’arrêt cardiocirculatoire.

Abstract

Cyanide poisoning most often occurs during accidental inhalation of fire fumes. Cyanide inhibits cytochrome oxidase mitochondrial resulting in a cessation of oxygen consumption with deviation metabolism to an anaerobic mode. Alongside the classic respiratory and neurological clinical signs, epidemiology of cardiovascular events is poorly documented. If cardiopulmonary arrest and hypotension are quickly identified, other cardiac signs must be recognized as arrhythmias, conduction and repolarisation including poisoned patients at low doses. The realization of an electrocardiogram is systematic. Given its potential severity, specific treatment of acute cyanide poisoning should be initiated without delay, immediately after the recognition of the symptoms. Of all antidotes, hydroxocobalamin is the firstline treatment. Administration is carried out intravenously on the average dosage of 5 g, which can be repeated, or even 10 g immediately in case of cardiac arrest.

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Authors and Affiliations

  1. Service d’accueil des urgences/Samu 25, CHRU Jean Minjoz, 3 boulevard Fleming, F-25030, Besançon cedex, France

    J. L. Fortin, E. Robeley, G. Capellier & T. Desmettre

  2. Service d’accueil des urgences/Samu 90, hôpital Nord Franche-Comté, 14 rue de Mulhouse, F-90000, Belfort, France

    J. L. Fortin

  3. Université de Bourgogne Franche-Comté, 1 rue Goudinel, F-25000, Besançon, France

    G. Capellier & T. Desmettre

Authors
  1. J. L. Fortin
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  2. E. Robeley
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  3. G. Capellier
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  4. T. Desmettre
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Correspondence to J. L. Fortin.

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Fortin, J.L., Robeley, E., Capellier, G. et al. Manifestations cardiovasculaires de l’intoxication cyanhydrique aiguë. Ann. Fr. Med. Urgence 6, 106–111 (2016). https://doi.org/10.1007/s13341-016-0633-4

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  • DOI: https://doi.org/10.1007/s13341-016-0633-4

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