Acute and Lethal Cyanide Poisoning: A Near-Drowning Accident in Cyanide Tank

急性、致死性氰化物中毒：一個溺入氰化物儲存槽的意外事件

蔡清和(Ching Ho Tsai) ； 李毓芹(Yu-Chin Lee) ； 彭殿王(Diahn-Warng Perng)

《胸腔醫學》 18卷2期 (2003/04) Pp. 145-149

摘要

氰化物會打斷粒線體的正常電子傳遞鏈，導致細胞無法在氧化磷酸化過程使用氧，造成厭氧代謝和乳酸酸血症。這裡我們提出一個嚴重氰化物中毒的病例。一個21歲青年意外落下溺入氰化物的儲存槽，30分鐘後在地區醫院已無意識及自發呼吸。心肺復甦術急救、氣管插管接上呼吸器後送到我們急診室。給予氰化物解毒劑，並在加護病房照顧。不幸的是，腎功能伴隨高乳酸及肌酸酐激媒繼續的昇高惡化，且血液氣體分析顯示動靜脈氧氣飽和度差減少。在住院後第29天，死於因氰化物中毒引起的多器官衰竭。這是一極為罕見致死性氰化物中毒的急症。從這病患的臨床觀察及治療，將使我們獲得更多寶貴經驗，利於爾後的治療。

關鍵字

氰化物中毒 ； 厭氧代謝 ； 乳酸酸血症 ； 氰化物解毒劑

並列摘要

Cyanide disrupts the functional electron transport chain and the ability of cells to utilize O2 in the process of oxidative phosphorylation, leading to an anaerobic metabolism and lactic acidosis. Herein, we present a case of severe cyanide intoxication. A 21-year-old young male was nearly drowned in a cyanide pool after falling into it. At a local hospital 30 minutes later, he appeared to have lost consciousness and was without spontaneous breathing. After cardiopulmonary resuscitation, he was intubated and assisted with mechanical ventilation and transferred to our emergency room. Cyanide antidotes were given and intensive care to maintain cardiopulmonary function was provided. Unfortunately, progressive deterioration of the renal function accompanied with high levels of lactate and creatine kinase was observed. Blood gas analysis revealed a decreased difference in arterio-venous O2 saturation. The patient expired 29 days after admission because of multiple organ failure secondary to cyanide intoxication. This is a very rare case of acute and lethal cyanide intoxication. The experience with clinical observation and treatment in this case may be of value to manage such patients in the future.

並列關鍵字

cyanide intoxication ； anaerobic metabolism ； lactic acidosis ； cyanide antidote