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Severe cyanide poisoning from an alternative medicine treatment with amygdalin and apricot kernels in a 4-year-old child

Schwere Zyanidvergiftung im Rahmen einer alternativmedizinischen Behandlung mit Amydalin und Aprikosenkernen bei einem 4-jährigen Jungen

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Summary

Background

The use of complementary and alternative medicine (CAM) is widespread in children with cancer and is poorly regulated.

Patients and methods

Case report.

Results

We describe a case of severe cyanide poisoning arising from CAM use. A severely agitated, encephalopathic, unresponsive 4-year-old boy (initial Glasgow Coma Scale of 3) with a history of metastatic ependymoma was brought to our emergency department by ambulance services. Initial blood gas analysis demonstrated severe metabolic/lactic acidosis. On detailed questioning of the parents, the use of CAM including intravenous and oral “vitamin B 17” (amygdalin) and oral apricot kernel was reported. After administering sodium thiosulfate, rapid improvement in his medical condition with complete recovery without need for further intensive care treatment was seen. Serum cyanide level was markedly elevated.

Conclusions

Cyanide poisoning can be the cause of severe encephalopathy in children receiving CAM treatment with substances containing cyanogenic glycosides.

Zusammenfassung

Hintergrund

Die Verwendung von Komplementär- und Alternativmedizin (CAM) findet bei pädiatrischen Patienten mit bösartigen Erkrankungen nicht selten statt.

Patienten und Methodik

Fallbericht.

Ergebnisse

Hier berichten wir über einen 4-jährigen Jungen mit einem metastasierten Ependymom, bei welchem es im Rahmen einer CAM-Behandlung zu einer schweren iatrogenen Zyanidvergiftung gekommen war. Klinisch imponierte ein enzephalopathisches Krankheitsbild mit Agitation und einer schweren initialen Bewusstseinsstörung (GCS: 3). Die bei Aufnahme durchgeführte Blutgasanalyse zeigte eine schwere metabolische Azidose mit ausgeprägter Laktaterhöhung. Nach intensiver Befragung der Eltern berichteten diese über die Inanspruchnahme von CAM-Therapien. Hierbei wurden über einen Zeitraum von rund einer Woche tägliche Infusionstherapien sowie orale Gaben mit sogenanntem „Vitamin B17“ durchgeführt. Nach Gabe von Natriumthiosulphat kam es zu einer raschen Besserung der klinischen Symptomatik ohne Auftreten von Residuen. Die toxikologische Bestimmung der Serumzyanidkonzentration ergab einen hochpathologischen Befund.

Schlussfolgerung

Bei Kindern, bei denen es zum Auftreten eines akuten enzephalopatischen Krankheitsbildes kommt, sollte differenzialdiagnostisch an eine iatrogene Zyanidintoxikation gedacht werden. Diese kann im Rahmen einer CAM-Therapie mit Amydalin und Aprikosenkernen auftreten.

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Fig. 1
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Abbreviations

CAM:

Complementary and alternative medicine

GCS:

Glasgow Coma Scale

MRI:

Magnetic resonance imaging

PICU:

Pediatric Intensive Care Unit

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Authors and Affiliations

  1. Department of Pediatric Intensive Care Medicine, University Children’s Hospital of Saarland, Building 9, 66421, Homburg, Germany

    Harald Sauer MD, Caroline Wollny MD, Isabel Oster MD & Erol Tutdibi MD

  2. Poison Control Center of Saarland, University Children’s Hospital of Saarland, Building 9, 66421, Homburg, Germany

    Harald Sauer MD, Erol Tutdibi MD,  Ludwig Gortner MD &  Sascha Meyer MD

  3. Department of Pediatrics, University Hospital of Saarland, Homburg, Germany

    Caroline Wollny MD, Erol Tutdibi MD,  Ludwig Gortner MD &  Sascha Meyer MD

  4. Department of Pediatric Pain and Palliative Services, University Hospital of Saarland, Homburg, Germany

    Isabel Oster MD,  Ludwig Gortner MD &  Sven Gottschling MD

  5. Department of Pediatrics and Pediatric Intensive Care Medicine, University Children’s Hospital of Saarland, Building 9, 66421, Homburg, Germany

    Isabel Oster MD &  Sascha Meyer MD

Authors
  1. Harald Sauer MD
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  2. Caroline Wollny MD
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  3. Isabel Oster MD
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  4. Erol Tutdibi MD
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  5. Ludwig Gortner MD
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  6. Sven Gottschling MD
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  7. Sascha Meyer MD
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Corresponding author

Correspondence to Sascha Meyer MD.

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Sauer, H., Wollny, C., Oster, I. et al. Severe cyanide poisoning from an alternative medicine treatment with amygdalin and apricot kernels in a 4-year-old child. Wien Med Wochenschr 165, 185–188 (2015). https://doi.org/10.1007/s10354-014-0340-7

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  • DOI: https://doi.org/10.1007/s10354-014-0340-7

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