De Paepe Peter, Colin Pieter, Depuydt Pieter, Decavele An-Sofie, De Smet Julie, Boussery Koen, Stove Christophe, Benoit Dominique, Verstraete Alain, Van Bocxlaer Jan, Buylaert Walter
a Department of Emergency Medicine , Ghent University Hospital , Ghent , Belgium.
b Heymans Institute of Pharmacology, Ghent University , Ghent , Belgium.
Clin Toxicol (Phila). 2016;54(1):56-60. doi: 10.3109/15563650.2015.1101770. Epub 2015 Dec 1.
Cyanide poisoning may be caused by acetonitrile, a common industrial organic solvent and laboratory agent.
To describe the potential use of disulfiram in treating acetonitrile poisoning in a human clinical case and to further study its effect in human liver microsomes in vitro.
A 30-year-old man initially presented with a cholinergic toxic syndrome following ingestion of aldicarb. Toxicological analysis revealed coingestion of ethanol. He subsequently developed severe metabolic acidosis caused by the cyanogenic compound acetonitrile which was erroneously interpreted as acetone in the chromatogram. After three treatments with hydroxocobalamin (5 g i.v.) and sodium thiosulfate (12.5 g i.v.) on days 2, 3, and 5, he had transient improvement but recurrent lactic acidosis. Treatment with disulfiram was associated on day 7 with resolution of metabolic acidosis and slowing of the decrease in acetonitrile concentration. He recovered from acetonitrile toxicity completely. The time course of acetonitrile, thiocyanate, and cyanide concentrations suggested that disulfiram inhibited cyanide formation.
In vitro experiments with human liver microsomes showed the cyanide concentration was significantly lower after incubation with acetonitrile and disulfiram than acetonitrile alone (a mean 60% reduction in cyanide level).
Although disulfiram was given late in the course of the poisoning it is possible that it contributed to the recovery.
氰化物中毒可能由乙腈引起，乙腈是一种常见的工业有机溶剂和实验室试剂。
描述双硫仑在治疗一例人类乙腈中毒临床病例中的潜在用途，并进一步研究其在人肝微粒体中的体外作用。
一名30岁男性在摄入涕灭威后最初出现胆碱能中毒综合征。毒理学分析显示同时摄入了乙醇。随后，他因氰化物化合物乙腈而出现严重代谢性酸中毒，在色谱图中被错误地解释为丙酮。在第2、3和5天接受三次羟钴胺素（静脉注射5克）和硫代硫酸钠（静脉注射12.5克）治疗后，他有短暂改善，但乳酸酸中毒复发。在第7天使用双硫仑治疗后，代谢性酸中毒得到缓解，乙腈浓度下降速度减慢。他从乙腈中毒中完全康复。乙腈、硫氰酸盐和氰化物浓度的时间进程表明双硫仑抑制了氰化物的形成。
用人肝微粒体进行的体外实验表明，与单独使用乙腈相比，乙腈和双硫仑孵育后氰化物浓度显著降低（氰化物水平平均降低60%）。
尽管双硫仑在中毒过程后期才使用，但它有可能促成了康复。
