Emergency Department, St Georges University Hospital NHS Foundation Trust, London, UK.
National Poisons Information Service, Cardiff Unit, University Hospital Llandough, Penarth, UK.
Clin Toxicol (Phila). 2022 Sep;60(9):1051-1058. doi: 10.1080/15563650.2022.2080074. Epub 2022 May 30.
Cyanide is a prevalent, lethal chemical. Possible sources of exposure include products of combustion, plant material, industry, chemical warfare and terrorism.
Retrospective review of UK Poisons Information Database of telephone enquiries to the National Poisons Information Service between 1 January 2008 and 31 December 2019 where cyanide poisoning was considered a possibility. Data extracted included demographics, exposure source, clinical features, Poisoning Severity Score, lactate concentration and antidotes given.
A total of 1,252 cases of suspected cyanide poisoning were identified, 239 (19%) involved children under 10 years. The commonest sources of exposure were ingestion of plant material (437 cases; 35%) and smoke inhalation (399; 32%). Smoke inhalation caused the majority of severe and fatal cases (139; 71%). Clinical features associated with fatal outcomes were cardiac arrest (OR 36.4; 95% CI 14.4-92.2), hypotension (15.8; 7.0-35.9), coma (10.8; 5.6-21.0) and lactic acidosis (7.8; 4.1-14.8). 110 patients (9%) were given an antidote and 40 patients (3%) died.Lactate concentrations correlate with Poisoning Severity Score category ( = 0.6, < 0.0001). Serum lactate <2.0 mmol/L was associated with Poisoning Severity Score None or Minor (sensitivity 76%; specificity 86%) and >11.0 mmol/L was associated with fatal outcome (sensitivity 74%; specificity 80%). 61 cases (5%) had severe carboxyhaemoglobin toxicity (COHb >30%). This was associated with a fatal outcome (OR 7.0; 95% CI 1.5-33.7) and there was positive correlation between carboxyhaemoglobin and Poisoning Severity Score, = 0.57, < 0.0001.
Most cases of ingestion of plant material involved children under five years and resulted in no or mild symptoms. In adults smoke inhalation was associated with the most severe poisoning. The lactate cut-off values associated with each severity score calculated in this study are lower than the values used by NPIS on TOXBASE. Analytical conformation of cyanide exposure was unavailable in the majority of case, limiting the strength of these conclusions.
氰化物是一种普遍存在且致命的化学物质。可能的暴露源包括燃烧产物、植物材料、工业、化学战和恐怖主义。
对英国毒物信息数据库（NPIS）自 2008 年 1 月 1 日至 2019 年 12 月 31 日期间接到的有关氰化物中毒可能性的电话咨询进行回顾性分析。提取的数据包括人口统计学、暴露源、临床特征、中毒严重程度评分、乳酸浓度和使用的解毒剂。
共发现 1252 例疑似氰化物中毒病例，239 例（19%）涉及 10 岁以下儿童。最常见的暴露源是摄入植物材料（437 例；35%）和吸入烟雾（399 例；32%）。吸入烟雾导致大多数严重和致命病例（139 例；71%）。与致命结局相关的临床特征包括心脏骤停（OR 36.4；95%CI 14.4-92.2）、低血压（15.8；7.0-35.9）、昏迷（10.8；5.6-21.0）和乳酸性酸中毒（7.8；4.1-14.8）。110 例患者（9%）接受了解毒剂治疗，40 例患者（3%）死亡。乳酸浓度与中毒严重程度评分相关（r=0.6，P<0.0001）。血清乳酸浓度<2.0mmol/L 与中毒严重程度评分无或轻度（敏感性 76%，特异性 86%）相关，>11.0mmol/L 与致命结局相关（敏感性 74%，特异性 80%）。61 例（5%）患者存在严重的碳氧血红蛋白毒性（COHb>30%）。这与致命结局相关（OR 7.0；95%CI 1.5-33.7），且碳氧血红蛋白与中毒严重程度评分之间存在正相关，r=0.57，P<0.0001。
大多数摄入植物材料的病例涉及 5 岁以下儿童，且无或症状较轻。在成人中，吸入烟雾与最严重的中毒有关。本研究中计算的每个严重程度评分的乳酸截止值低于 NPIS 在 TOXBASE 中使用的值。由于大多数病例无法进行氰化物暴露的分析确认，限制了这些结论的说服力。
