Severe suicidal self-poisoning with massive dose of potassium ferricyanide(III): hyperkalemia but not free cyanide may cause death
Abstract
Potassium ferricyanide(III), K-3[Fe(CN)(6)], has a widespread use in blueprint drawing, photography, chemical industry, and metallurgy. In mice, the oral lethal dose 50 (LD50) is 1600 mg kg(-1).
We report the case of a suicide attempt in a 37-year-old male by intentional ingestion of 80 g of potassium ferricyanide(III) dissolved in water. The estimated ingested dose was 770 mg kg(-1).
The patient reported vertigo as the first sign of poisoning and six episodes of diarrhea with dark-colored stool 2 h after ingestion. The patient was transported by ambulance to the intensive care unit 8 h after ingestion.
He was conscious and spontaneously ventilating, with a Glasgow Coma Scale (GCS) score of 15. On ECG performed at admission, tall "tented" T waves in V3-V6 and progressive flattering of P waves were registered.
Serum concentrations of potassium of 7.2 mmol dm(-3), urea of 7.1 mmol dm(-3), and creatinine of 162 A mu mol dm(-3) indicated development of acute renal failure. Despite the administration of intravenous insulin and 10% glucose infusion during the first hours after admission, there was a further elevation of serum potassium to 7.4 mmol dm(-3) suggesting acute renal failure.
For this reason, intermittent hemodialysis was performed [duration 200 min, blood flow rate 147 cm(3) min(-1), online clearance monitoring (OCM) clearance rate 100 cm(3) min(-1), and substitution fluid volume 5.8 dm(3)]. The condition of the patient stabilized and he was discharged from hospital on the fourth day after admission.
This case report demonstrates the risks of life-threatening hyperkalemia and acute renal failure as complications of massive ingestion of potassium ferricyanide(III).