De Capitani Eduardo Mello, Borrasca-Fernandes Carla Fernanda, Branco Pimenta Maíra, Prado Camila Carbone, Soubhia Paula Christiane, Lanaro Rafael, Mello Moreira Sueli, Linden Rafael, Nóbrega Helena Valle, Bucaretchi Fábio, Costa José Luiz
a Campinas Poison Control Center , University of Campinas , São Paulo , Brazil.
b School of Medicine , University of Campinas , São Paulo , Brazil.
Clin Toxicol (Phila). 2017 Sep;55(8):929-933. doi: 10.1080/15563650.2017.1324977. Epub 2017 May 11.
Acetonitrile (ACN) is a solvent rapidly absorbed through lungs and intestinal tract, and is slowly metabolized to cyanide (CN) by enzymatic processes mediated by CYP2E1.
To describe the clinical and laboratory evolution, ACN elimination half-life, and its presence in breast milk in a nursing mother who attempted suicide.
A 25-year-old 2-month nursing mother ingested an estimated dose of 2.1 g/kg of ACN. Blood and urine samples were collected 24 h later for ACN, CN and thiocyanate analysis, and 12.5 g sodium thiosulfate i.v. in 1-h infusion was started and repeated every 24 h for 4 days. ACN results showed 200 mg/L in blood and 235 mg/L in urine. ACN analysis in the breast milk at Day 6 showed level of 21 mg/L compared to 27 mg/L in blood collected at the same time, suggesting a possible relationship of 1.3:1.0 ratio. An elimination half-life of 40.4 h was calculated, compared to 32 and 36 h showed in other studies.
The clinical management must involve the use of CN antidotes for more than 24 h depending on the symptoms and blood levels of ACN. Furthermore, our data showed the possible existence of a close relationship between plasma and breast milk levels.
乙腈（ACN）是一种可通过肺和肠道迅速吸收的溶剂，并通过细胞色素P450 2E1介导的酶促过程缓慢代谢为氰化物（CN）。
描述一名企图自杀的哺乳期母亲的临床和实验室演变、ACN消除半衰期及其在母乳中的存在情况。
一名25岁、处于哺乳期2个月的母亲摄入了估计剂量为2.1 g/kg的ACN。24小时后采集血液和尿液样本进行ACN、CN和硫氰酸盐分析，并开始静脉输注12.5 g硫代硫酸钠，1小时内输完，每24小时重复一次，共进行4天。ACN检测结果显示血液中为200 mg/L，尿液中为235 mg/L。第6天母乳中的ACN分析显示水平为21 mg/L，而同时采集的血液中为27 mg/L，表明可能存在1.3:1.0的比例关系。计算出消除半衰期为40.4小时，而其他研究显示为32和36小时。
临床管理必须根据ACN的症状和血液水平使用CN解毒剂超过24小时。此外，我们的数据显示血浆和母乳水平之间可能存在密切关系。
