US EPA

1031234 

Journal Article 

Cyanide and arsenic poisoning by intravenous injection 

DiNapoli, J; Hall, AH; Drake, R; Rumack, BH 

1989 

Yes 

Annals of Emergency Medicine
ISSN: 0196-0644
EISSN: 1097-6760 

BIOSIS/89/17028 

18 

3 

308-311 

English 

2538098 

10.1016/s0196-0644(89)80420-2 

WOS:A1989T568100017 

A 29-year-old man was found unresponsive a few minutes after self-injecting undetermined amounts of potassium cyanide and sodium arsenite intravenously in a suicide attempt. Treatment with the Lilly Cyanide Antidote kit rapidly resolved the initial coma, despite a whole blood cyanide level of 4.4 micrograms/mL. A 12-hour urine arsenic collection begun on admission showed 10,065 micrograms arsenic/12 hr. The patient received intramuscular BAL initially, which was followed by two ten-day courses of oral D-penicillamine. Complications included upper gastrointestinal tract bleeding requiring transfusion, transient elevations of liver function tests, self-limited complaints of decreased vision with conjunctival hyperemia and photophobia, and an abscess at the injection site. Although specific antidote therapy completely resolved the cyanide toxicity, early and prolonged arsenic chelation did not prevent a mild sensory peripheral neuropathy from developing with onset about 17 days after self-injection. 

Biochemical Studies-General; Pathology; Digestive System-Pathology; Cardiovascular System-General; Cardiovascular System-Blood Vessel Pathology; Integumentary System-Pathology; Sense Organs; Pharmacology-Clinical Pharmacology (1972- ); Routes of Immunization; Toxicology-General; Toxicology-Antidotes and Preventative Toxicology (1972- ); Hominidae