Analysis of the treatment of two cases of occupational acute cyanide poisoning

Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2026 Aug 20;44(8):682-685. doi: 10.3760/cma.j.cn121094-20250211-00053.

ABSTRACT

To report the treatment experience of two cases of occupational acute cyanide poisoning. Both of the two patients were transport truck drivers who entered a storage tank of the transport truck to inspect the empying of wastewater containing sodium cyanide and to clean the tank without any protective measures on November 14, 2024. They suffered acute poisoning due to inhalation of hydrogen cyanide and dermal contact with sodium cyanide aqueous solution. One patient (case 1) had severe poisoning, presenting with coma, paroxysmal tonic convulsions of limbs, respiratory failure, and metabolic acidosis. After receiving tracheal intubation with mechanical ventilation, specific antidotes (methylene blue 10 mg/kg combined with sodium thiosulfate, total dose 18.75 g), correction of acidosis, and prevention of cerebral edema, the patient regained consciousness and was weaned from ventilator on day 1, and was discharged on day 10 with no neurological sequelae at half month follow up. The other patient (case 2) had mild poisoning, presenting with dizziness, nausea, and chest tightness, and recovered after symptomatic supportive treatment. It is suggested that early administration of specific antidotes combined with respiratory support and prevention of cerebral edema are the keys to the treatment of severe cyanide poisoning, and the awareness of occupational safety protection should be strengthened for workers operating in confined spaces.

PMID:42706020 | DOI:10.3760/cma.j.cn121094-20250211-00053