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Novel treatment (new drug/intervention; established drug/procedure in new situation)
Hydroxocobalamin treatment of acute cyanide poisoning from apricot kernels
  1. Davide Cigolini1,
  2. Giogio Ricci1,
  3. Massimo Zannoni1,
  4. Rosalia Codogni1,
  5. Manuela De Luca2,
  6. Paola Perfetti2,
  7. Giampaolo Rocca2
  1. 1UOS di Tossicologia Clinica, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
  2. 2UOC di Pronto Soccorso, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
  1. Correspondence to Dr Davide Cigolini; davide.cigolini{at}


Clinical experience with hydroxocobalamin in acute cyanide poisoning via ingestion remains limited. This case concerns a 35-year-old mentally ill woman who consumed more than 20 apricot kernels. Published literature suggests each kernel would have contained cyanide concentrations ranging from 0.122 to 4.09 mg/g (average 2.92 mg/g). On arrival, the woman appeared asymptomatic with a raised pulse rate and slight metabolic acidosis. Forty minutes after admission (approximately 70 min postingestion), the patient experienced headache, nausea and dyspnoea, and was hypotensive, hypoxic and tachypnoeic. Following treatment with amyl nitrite and sodium thiosulphate, her methaemoglobin level was 10%. This prompted the administration of oxygen, which evoked a slight improvement in her vital signs. Hydroxocobalamin was then administered. After 24 h, she was completely asymptomatic with normalised blood pressure and other haemodynamic parameters. This case reinforces the safety and effectiveness of hydroxocobalamin in acute cyanide poisoning by ingestion.

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  • This is a reprint of a paper that first appeared in BMJ Case Reports, BMJ Case Reports 2011; doi:10.1136/bcr.03.2011.3932.

  • Competing interests None.

  • Patient consent Obtained.