Acetonitrile Poisoning for Suicidal Purposes Treated with Hydroxycobalamin and Disulfiram-Case Report

Acetonitrile (methyl cyanide) is an organic solvent mainly used in laboratories and chemical industries. It is very rare poison used to commit suicide. It can be absorbed through the skin, orally or by inhalation. Toxicity of acetonitrile is caused by releasing cyanide and formaldehyde in delayed hepatic metabolism. Cyanide transforms aerobic metabolism into anaerobic metabolism, which by product is lactic acid. Symptoms of acute cyanide poisoning are headache, nausea, anxiety, confusion, drowsiness, tachycardia and tachypnoea. There are known several cyanide antidotes: the Cyanide Antidote Kit, 4-dimethylaminophenol, dicobalt edetate and hydroxycobalamin. This is the first case of acetonitrile poisoning reported in Poland, which was successfully treated with hydroxycobalamin and disulfiram. A 16-year-old boy poisoned himself with acetonitrile for suicidal purposes. Neurological and cardiovascular symptoms appeared after 10 hours after ingestion. The laboratory analysis showed severe metabolic acidosis with base deficiency and high concentration of lacid acid. He was admitted to Intensive Care Unit in serious condition and started treated with hydroxycobalamin (5g i.v.). After first dose he responded quickly, by regaining consciousness and normalizing lactic acid. On days 2, 3 and 4 lacid acid was increasing again and consciousness were observed and he required further doses of hydroxycobalamin. In search of other therapeutic methods, disulfiram was added to treatment on day 4. The metabolism is probably based on the inhibition of cytochrome P450 which transform acetonitrile to cyanide. After adding disulfiram to treatment the boy was completely cured.