Konstantatos Alex, Shiv Kumar Malini, Burrell Aidan, Smith Joel
Departments of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia.
BMJ Case Rep. 2017 Sep 11;2017:bcr-2017-220814. doi: 10.1136/bcr-2017-220814.
Hypoxia under general anaesthesia is a potentially life-threatening condition. A seemingly well 67-year-old man appeared hypoxic with peripheral pulse oximetric measurement during routine anaesthesia. Postoperatively, the patient admitted to daily self-prescription of apricot kernel extract for a period of 5 years. Apricot kernel is a commonly taken extract used for a range of ailments, and is associated with cyanide toxicity, which was confirmed through blood analysis. Our explanation for the hypoxic measurement was the presence of free cyanide interfering with functioning of the peripheral pulse oximeter. On cessation of the apricot kernel extract, peripheral oxygen saturations returned to normal. Cardiac and respiratory causes together with rare haemoglobinopathies were excluded. This case illustrates how chronic dosing of complementary medicines can result in harmful toxicities, which may carry potential for serious consequences and how these chronic toxicities may present to physicians in atypical ways.
全身麻醉下的低氧血症是一种潜在的危及生命的状况。一名看似健康的67岁男性在常规麻醉期间经外周脉搏血氧饱和度测量显示为低氧状态。术后，患者承认有5年的时间每天自行服用杏仁提取物。杏仁是一种常用于多种疾病的提取物，与氰化物中毒有关，血液分析证实了这一点。我们对低氧测量结果的解释是游离氰化物的存在干扰了外周脉搏血氧仪的功能。停止服用杏仁提取物后，外周血氧饱和度恢复正常。排除了心脏和呼吸方面的原因以及罕见的血红蛋白病。该病例说明了长期服用补充药物如何导致有害毒性，这可能带来严重后果，以及这些慢性毒性如何以非典型方式呈现给医生。
