Case Report of Lethal Toxin Lurking in an Edible Plant

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Pallav Patel
Venu Madhav Konala
Sreedhar Adapa
Vijay Gayam
Prem Sahasranam
Subhasish Bose
Candice D Golez
Srikanth Naramala

Keywords

cassava, cyanide poisoning, sodium nitrite, hydroxycobalamine, sodium thiosulfate

Abstract

Cyanide is notoriously known to the public for more than a century now as a weapon of mass destruction (Zyklon B gas – hydrogen cyanide used by Nazis), an agent for chemical warfare during World War I (hydrogen cyanide) and very infamous “Suicide Pill” used in the past by military and espionage organizations during World War II (potassium cyanide). During the modern industrial era, cyanide poison-ing is commonly associated with the industrial exposure and domestic fires. But there is little awareness about potentially fatal consequences of cyanide poisoning from common food sources. Here, we present the case report of a 79-year old female with acute cyanide poisoning from improperly prepared cassava leaves. Symptoms from ingested toxin may start a few hours after exposure, which include headache, confusion, ataxia, seizures, palpitations, nausea, vomiting, abdominal pain, flushing, and itching of the skin. Patients may develop hypotension, cardiac arrhythmias, renal failure, hepatic necrosis, rhabdomyolysis, and metabolic acidosis; a multisystem manifestation of hypoxia at the cellular level.

Multiple treatment strategies are available to treat cyanide poisoning, including sodium nitrite, sodium thiosulfate, and hydroxycobalamine. This is one of the scenarios where a thorough history, awareness of agents causing cyanide toxicity and knowledge of clinical manifestations can help avoid delays in prompt decision making for appropriate treatment, thus reducing morbidity, mortality, and prolonged hospital course.
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