Acute intoxication by acetonitrile

Malo Barres, Roger; Muñoz Muñoz, Cándido; Sanchez Sitjes, Lluis

doi:10.1016/j.medcle.2019.06.035

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These findings suggest diffuse axonal injury." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Alba Lopez-Fernández, Manuel Quintana-Diaz, Manuel Sánchez-Sánchez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Alba" "apellidos" => "Lopez-Fernández" ] 1 => array:2 [ "nombre" => "Manuel" "apellidos" => "Quintana-Diaz" ] 2 => array:2 [ "nombre" => "Manuel" "apellidos" => "Sánchez-Sánchez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775320303602" "doi" => "10.1016/j.medcli.2020.06.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775320303602?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620303843?idApp=UINPBA00004N" "url" => "/23870206/0000015500000006/v2_202102250949/S2387020620303843/v2_202102250949/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "Acute intoxication by acetonitrile" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "275" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Roger Malo Barres, Cándido Muñoz Muñoz, Lluis Sanchez Sitjes" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Roger" "apellidos" => "Malo Barres" ] 1 => array:4 [ "nombre" => "Cándido" "apellidos" => "Muñoz Muñoz" "email" => array:1 [ 0 => "leofranco@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "Lluis" "apellidos" => "Sanchez Sitjes" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Medicina Interna, Hospital General de Cataluña, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Intoxicación aguda por acetonitrilo" ] ] "textoCompleto" => "Acetonitrile (ACN or CH3CN) is a flammable liquid that was used in the manufacture of cosmetic products and was withdrawn in 2000 for that use due to its skin toxicity. Currently, it is used as an organic solvent in refineries, manufacture of pesticides or pharmaceutical products, among other uses.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Acetonitrile poisoning is a rare cause of poisoning and represents a medical emergency. It usually occurs by inhalation, ingestion, or accidental skin absorption, mainly in a work context.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> Although there are some previously reported cases of incidental or suicidal poisoning,<a class="elsevierStyleCrossRef" href="#bib0015">3</a> those described in the literature since its withdrawal for use by the general population are few.We report the case of a 39-year-old man, a chemical industry worker, a former smoker with a history of mixed anxiety-depressive disorder who was admitted to our center due to nausea and vomiting after occupational exposure during the clean-up of a liquid ACN spill. Although he was wearing personal protective equipment, the mask was intermittently removed. During the 24 h before admission he suffered from asthenia and anorexia, but did not seek medical help. Upon arrival at our center, he was admitted to the intensive care unit, tachypnoeic at 24 bpm and with 97% baseline saturation. Regarding laboratory parameters, leukocytosis of 14.7 × 103, baseline arterial blood gas: pH 7.5; pCO2: 18.3 mmHg; HCO3: 14.4 meEq/l; excess cell bases: ↓8.2 mEq/l standard; pO2 116 mmHg and lactic acid 52 mg/dl (4.5–14.4) stood out. Urine toxicology analysis showed thiocyanate (acetonitrile metabolite) levels of 65 mg/l (reference value < 20 mg/l in exposed people). Chest X-ray and electrocardiogram showed no abnormalities. Support measures were started with oxygen therapy and IV hydration therapy with subsequent administration of a single dose of 12.5 g of sodium thiosulfate IV and 5 g of hydroxocobalamin IV with progressive resolution of the clinical symptoms in the following 72 h.Acetonitrile poisoning should be suspected in cases of suggestive clinical features and elevated lactate levels, as in our patient. The fact that it is a colourless, volatile liquid and non-specific symptoms do not appear until several hours after inhalation exposure may delay diagnosis.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> These symptoms include headache, vertigo, nausea, vomiting, breathing difficulties, and in more severe cases, seizures, or death from respiratory failure as a consequence of the liver's metabolization of acetonitrile to methyl cyanide. The first-line treatment is hydroxycobalamin.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> This acts quickly and efficiently by changing the hydroxyl group for cyanide, forming cyanocobalamin (vitamin B12). However, in massive poisoning it can be associated with sodium thiosulfate that reverses anaerobiosis and lactic acidosis caused by cyanide at the mitochondrial level, although it does so more slowly. Because the metabolization of ACN to cyanide is slower than that of other nitriles, its toxicity occurs less abruptly allowing a wider time window for neutralization and excretion by urine or exhalation without being metabolized. Our patient responded satisfactorily to treatment despite the delay in seeking medical help and taking the antidote.Acetonitrile poisoning is a rare cause of poisoning. A quick diagnostic and therapeutic approach in the first hours after exposure can avoid a fatal outcome." 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"serieFecha" => "2015" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cyanides" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.P. Morocco" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ccc.2005.06.002" "Revista" => array:5 [ "tituloSerie" => "Crit Care Clin." "fecha" => "2005" "volumen" => "21" "paginaInicial" => "691" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16168309" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Suicide attempt with acetonitrile ingestion in a nursing mother" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.M. De Capitani" 1 => "C.F. Borrasca-Fernandes" 2 => "M. Branco Pimenta" 3 => "C.C. Prado" 4 => "P.C. Soubhia" 5 => "R. Lanaro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/15563650.2017.1324977" "Revista" => array:6 [ "tituloSerie" => "Clin Toxicol (Phila)." "fecha" => "2017" "volumen" => "55" "paginaInicial" => "929" "paginaFinal" => "933" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28494173" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A review on ingested cyanide: risks, clinical presentation, diagnostics, and treatment challenges" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T.B. Hendry-Hofer" 1 => "P.C. Ng" 2 => "A.E. Witeof" 3 => "S.B. Mahon" 4 => "M. Brenner" 5 => "G.R. Boss" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "J Med Toxicol." "fecha" => "2019" "volumen" => "15" "paginaInicial" => "128" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hydroxocobalamin for severe acute cyanide poisoning by ingestion or inhalation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.W. Borron" 1 => "F.J. Baud" 2 => "B. Mégarbane" 3 => "C. Bismuth" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ajem.2006.10.010" "Revista" => array:5 [ "tituloSerie" => "Am J Emerg Med." 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