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Various toxicities: case report A 26-year-old woman developed nausea, vomiting, dizziness, fatigue, lactic acidosis and hypotension secondary to cyanide toxicity following overdose of amygdalin in a suicide attempt. Additionally, she also received ascorbic acid in a suicide attempt. The woman was brought to the emergency department following ingestion of 10 tablets of amygdalin 500mg and unknown amount of ascorbic acid [vitamin C] 24 hours prior to presentation in a self-harm attempt (suicide attempt). It was reported that she developed nausea and vomiting after the ingestion. Also, she developed dizziness and fatigue. Further examinations showed body temperature 37.3°C, HR 138 beats/min; BP 131/67mm Hg; O2 saturation (SpO2) 98% on room air and lactate of 3.2 mmol/L. Approximately 5.5 hours after the presentation, she vomited again. Repeated lactate level was 10.5 mmol/L, HR was 99 beats/min, BP 103/55mm Hg and SpO2 was 95%. In view of progressive lactic acidosis and hypotension, the woman was treated with hydroxocobalamin. Her symptoms and lactate level improved. She was monitored for 24 hours, and her lactate level did not increase, or the symptoms did not recur. She was then shifted to the psychiatry unit. It was determined that she had ingested amygdalin and ascorbic acid just prior to the presentation, and not 24 hours prior as reported. The amygdalin ingestion caused cyanide toxicity. She had ingested ascorbic acid to worsen the toxicity. However, it was evident that the acute ingestion of ascorbic acid did not affect her clinical course. Minhaj FS, et al. Does combining vitamin C and vitamin B17 (amygdalin) worsen toxicity?. Clinical Toxicology 58: 544, No. 6, May 2020. Available from: URL: http:// 803502877 doi.org/10.1080/15563650.2020.1741981 [abstract]

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Reactions 26 Sep 2020 No. 1823