• Harald Sauer, Caroline Wollny, Isabel Oster, Erol Tutdibi, Ludwig Gortner, Sven Gottschling, and Sascha Meyer.
• Department of Pediatric Intensive Care Medicine, University Children's Hospital of Saarland, Building 9, 66421, Homburg, Germany, harald.sauer@uks.eu.
• Wien Med Wochenschr. 2015 May 1; 165 (9-10): 185-8.

BackgroundThe use of complementary and alternative medicine (CAM) is widespread in children with cancer and is poorly regulated.Patients And MethodsCase report.ResultsWe describe a case of severe cyanide poisoning arising from CAM use. A severely agitated, encephalopathic, unresponsive 4-year-old boy (initial Glasgow Coma Scale of 3) with a history of metastatic ependymoma was brought to our emergency department by ambulance services. Initial blood gas analysis demonstrated severe metabolic/lactic acidosis. On detailed questioning of the parents, the use of CAM including intravenous and oral "vitamin B 17" (amygdalin) and oral apricot kernel was reported. After administering sodium thiosulfate, rapid improvement in his medical condition with complete recovery without need for further intensive care treatment was seen. Serum cyanide level was markedly elevated.ConclusionsCyanide poisoning can be the cause of severe encephalopathy in children receiving CAM treatment with substances containing cyanogenic glycosides.

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