Geller R J, Ekins B R, Iknoian R C
Fresno Regional Poison Control Center, Fresno Community Hospital and Medical Center, CA 93721.
Am J Emerg Med. 1991 May;9(3):268-70. doi: 10.1016/0735-6757(91)90093-y.
A patient presented without symptoms 30 minutes after ingesting acetonitrile, also known as methylacyanide. He had prompt gastric lavage and activated charcoal administration. Hours later, the onset of clinical toxicity was heralded by mental status abnormalities and vomiting prior to a generalized seizure. Following administration of sodium thiosulfate, the patient made an uneventful recovery. A blood cyanide level drawn shortly after presentation, but reported after the patient had been discharged, documented significant exposure. During hospitalization, cyanide toxicity was inferred from the history of ingestion of acetonitrile, plus a significant absence of venous blood hemoglobin desaturation. Because even small amounts can be harmful and toxicity is delayed, all acetonitrile ingestions should be presumed dangerous. Patients should be observed and repeatedly evaluated for at least 24 hours. In the absence of cyanide level determinations, lethargy, vomiting, seizures, and the lack of normal venous blood hemoglobin desaturation are clues to cyanide toxicity.
一名患者在摄入乙腈（也称为甲基氰）30分钟后无任何症状。他立即接受了洗胃和活性炭给药。数小时后，临床毒性发作的先兆是精神状态异常和呕吐，随后出现全身性癫痫发作。给予硫代硫酸钠后，患者顺利康复。就诊后不久采集的血氰化物水平，在患者出院后才报告，显示有大量接触。住院期间，根据摄入乙腈的病史以及静脉血血红蛋白明显未出现去饱和现象推断出氰化物中毒。由于即使少量乙腈也可能有害且毒性发作有延迟，所有乙腈摄入都应被视为危险情况。患者应至少观察24小时并反复评估。在无法测定氰化物水平的情况下，嗜睡、呕吐、癫痫发作以及静脉血血红蛋白未出现正常去饱和现象是氰化物中毒的线索。
