Change in National Dosing Advice of Nitroprusside After Potentially Fatal Cyanide Intoxication

The aim of this brief communication is to provide a short overview of cyanide intoxication following infusion of sodium nitroprusside (SNP). SNP is a fast-acting antihypertensive drug frequently used in of hypertensive emergencies. Although SNP is widely known as a safe to use drug, it can cause a potentially lethal cyanide intoxication. The difficulty to diagnose cyanide intoxication and pharmacological principles will be discussed. Hereby, we like to regain attention for this severe complication. As a result of our experience, the Dutch national paediatric drug formulary has been updated with additional warnings and recommendations. Cyanide intoxication due to sodium nitroprusside is a severe and difficult to recognize complication with potentially lethal outcome. Clinicians prescribing sodium nitroprusside should always be aware of its toxic effects.

Cyanide intoxication by apricot kernels: A case report and literature review

Acute cyanide intoxication is a serious healthcare problem due to its potentially life threatening and fatal toxic effects. Ingestion of cyanide containing foods is an important source of cyanide poisoning and apricot kernels contain significant amounts of such cyanogenic compounds. Herein we report a previously healthy 4- year-old boy admitted to our emergency department with complaints of vomiting and sudden onset of unconsciousness after ingestion of apricot kernels. He was diagnosed as acute cyanide poisoning and treated with a specific antidote; hydroxocobalamin. Our report concludes with previous cases of cyanide poisoning after ingestion of apricot kernels and a quick look at sources, manifestations and treatment of acute cyanide poisoning.

Soil nutrient adequacy for optimal cassava growth, implications on cyanogenic glucoside production: a case of konzo-affected Mtwara region, Tanzania

Soils in areas affected by konzo (a cassava cyanide intoxication paralytic disorder) are predominantly infertile and probably unable to supply cassava the nutrients it needs to achieve optimal growth. The soil nutrient levels in these areas, could also be influencing cyanogenic glucoside production in cultivated cassava, however there is hardly any knowledge on this. An assessment of soil nutrient levels on cassava fields in konzo-affected areas was therefore carried out to determine their adequacy for optimal cassava growth and how this influences cassava cyanogenic glucoside production. Konzo-affected Mtwara region, in Tanzania, was used as a case study area. Correlations between total hydrogen cyanide (HCN) levels in cassava roots and various soil nutrient levels on cassava fields were carried out and relationships between cyanide intoxication and soil nutrient levels on fields from which toxic cassava roots had been harvested were also investigated. The results showed that cassava grows under conditions of severe nutrient stress in the region. Soil nutrients found to be deficient on most fields, like potassium (mean = 0.09, SD = 0.05 cmol/kg), magnesium (mean = 0.26, SD = 0.14 cmol/kg) and zinc (mean = 1.34, SD = 0.26 mg/kg), are known to reduce cyanogenic glucoside levels in cassava roots when adequate in soils. Cyanogenic glucoside levels in cassava roots however increased by high levels soil phosphorous (rs = 0.486, p = 0.026 for all varieties) and sulphur (rs = 0.593, p = 0.032 and rs = 0.714, p = 0.047; for bitter and sweet cassava varieties, respectively) on these soils. The likelihood of cassava cyanide intoxication was also increased on fields with high pH and iron levels. High levels of sulphur and phosphorus, to very high levels of iron occurred on some fields. How soil nutrient supply influences cassava cyanogenic glucoside production in the konzo-affected areas was established.