a Division of Medical Toxicology, Department of Emergency Medicine , University of Virginia School of Medicine , Charlottesville , VA , USA.
Clin Toxicol (Phila). 2018 Jul;56(7):609-617. doi: 10.1080/15563650.2018.1435886. Epub 2018 Feb 8.
The aim of this systematic review was to identify isolated acute cyanide poison cases and to identify reported signs, symptoms, and laboratory findings.
We searched MEDLINE, Cochrane Reviews, and Web of Science case reports and series using a number of MeSH descriptors pertaining to cyanide, toxicity, and poisonings. We excluded studies on plants, laboratory analyses, smoke inhalation poisonings, animals as well as non-English language articles and those in which data were not available. Data extracted included demographics, exposure characteristics, acute signs/symptoms, and medical management and outcome.
From the initial 2976 articles retrieved, 65 articles (52 case reports, 13 case series) met inclusion criteria and described 102 patients. Most patients were unresponsive (78%), hypotensive (54%), or had respiratory failure (73%); other signs and symptoms included cardiac arrest (20%), seizures (20%), cyanosis (15%), cherry red skin (11%), and had an odor present (15%). Medical management included cyanide antidote kit (20%), sodium thiosulfate (40%), and hydroxocobalamin (29%). The majority of cases (66%) required intubation with mechanical ventilation and a substantial number (39%) developed refractory hypotension requiring vasopressor support.
Contrary to general reviews published on cyanide toxicity, reports of cherry red skin and bitter almond odor were rare among published cyanide cases. Consistent with other studies, metabolic acidosis with significant lactic acidosis were the laboratory values consistently associated with cyanide toxicity. Healthcare providers may overlook cyanide toxicity in the differential diagnosis, if certain expected characteristics, such as the odor of almonds or a cherry red color of the skin are absent on physical examination.
本系统评价旨在确定孤立的急性氰化物中毒病例，并确定报告的体征、症状和实验室发现。
我们使用与氰化物、毒性和中毒有关的多个 MeSH 描述符，在 MEDLINE、Cochrane 综述和 Web of Science 病例报告和系列中进行了搜索。我们排除了关于植物、实验室分析、烟雾吸入中毒、动物以及非英语文章和数据不可用的文章。提取的数据包括人口统计学特征、暴露特征、急性体征/症状以及医疗管理和结果。
从最初检索到的 2976 篇文章中，有 65 篇文章（52 篇病例报告，13 篇病例系列）符合纳入标准，描述了 102 例患者。大多数患者无反应（78%）、低血压（54%）或呼吸衰竭（73%）；其他体征和症状包括心脏骤停（20%）、癫痫发作（20%）、发绀（15%）、樱桃红皮肤（11%）和有气味（15%）。医疗管理包括氰化物解毒剂（20%）、硫代硫酸钠（40%）和羟钴胺素（29%）。大多数病例（66%）需要插管机械通气，相当数量（39%）的病例出现难治性低血压，需要血管加压支持。
与关于氰化物毒性的一般综述相反，在已发表的氰化物病例中，樱桃红皮肤和苦杏仁气味的报告很少见。与其他研究一致，代谢性酸中毒伴显著乳酸酸中毒是与氰化物毒性一致相关的实验室值。如果在体格检查中缺乏某些预期特征，如杏仁气味或皮肤呈樱桃红色，则医疗保健提供者可能会在鉴别诊断中忽略氰化物毒性。
