Chan C K, Chan M H M, Tse M L, Chan I H S, Cheung R C K, Lam C W K, Lau F L
Hong Kong Poison Information Centre, United Christian Hospital, Kwun Tong, Hong Kong, China.
Clin Toxicol (Phila). 2009 Jul;47(6):592-4. doi: 10.1080/15563650902997831.
Nonradioactive cesium chloride (CsCl) is used by some alternative medicine advocates as a treatment for cancer. The therapy was proven to be neither safe nor effective. Chronic use of CsCl has resulted in cases with severe cardiotoxicity.
A 65-year-old lady presented to our hospital's accident and emergency department with recurrent syncope attacks. Electrocardiogram monitoring showed QT prolongation and transient Torsades de Pointes (TDP) ventricular tachycardia. She was taking anticancer naturopathic drugs for 6 weeks before admission. One of her naturopathic drugs was subsequently confirmed containing 89% CsCl by weight. Besides conventional treatment of QT prolongation and TDP, the patient was given a 4-week course of oral Prussian blue to enhance gastrointestinal elimination of cesium. The serum half-life of cesium was reduced from 61.7 to 29.4 days after the use of Prussian blue. QT prolongation was normalized in 27 days.
To our knowledge, this is the first published case of nonradioactive cesium poisoning treated with Prussian blue. A transient rise in serum cesium level was observed during Prussian blue therapy. Possible explanations for this observation include poor drug compliance during outpatient treatment and redistribution of cesium from body stores.
Nonradioactive CsCl poisoning can result in severe cardiotoxicity with QT prolongation and TDP ventricular tachycardia. The key points in the management of nonradioactive cesium poisoning include cessation of cesium exposure, vigorous electrolytes replacement, and oral Prussian blue therapy.
一些替代医学倡导者使用非放射性氯化铯（CsCl）治疗癌症。事实证明，这种疗法既不安全也无效。长期使用CsCl已导致出现严重心脏毒性的病例。
一名65岁女性因反复晕厥发作就诊于我院急诊科。心电图监测显示QT间期延长和短暂尖端扭转型室性心动过速（TDP）。入院前她服用抗癌自然疗法药物6周。随后证实她的一种自然疗法药物按重量计含89%的CsCl。除了对QT间期延长和TDP进行常规治疗外，给予患者为期4周的口服普鲁士蓝疗程，以促进胃肠道对铯的清除。使用普鲁士蓝后，铯的血清半衰期从61.7天降至29.4天。27天时QT间期延长恢复正常。
据我们所知，这是首例使用普鲁士蓝治疗非放射性铯中毒的已发表病例。在普鲁士蓝治疗期间观察到血清铯水平短暂升高。对此观察结果的可能解释包括门诊治疗期间药物依从性差以及铯从体内储存部位重新分布。
非放射性CsCl中毒可导致严重心脏毒性，伴有QT间期延长和TDP室性心动过速。非放射性铯中毒管理的关键点包括停止接触铯、积极补充电解质以及口服普鲁士蓝治疗。
