{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,17]],"date-time":"2026-01-17T09:07:23Z","timestamp":1768640843726,"version":"3.49.0"},"reference-count":18,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,1,8]],"date-time":"2024-01-08T00:00:00Z","timestamp":1704672000000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Key Clinical Message<\/jats:title><jats:p>We present a case of a 36\u2010year\u2010old woman with a history of three suicide attempts who had ingested approximately 40 bitter almonds in a suicidal act, leading to her admission to the emergency department of a regional hospital due to complaints of vomiting. Upon arrival, she exhibited confusion, and her vital signs were recorded as follows: pulse rate\u2009=\u2009117 beats\/min, blood pressure\u2009=\u2009160\/85\u2009mmHg, oxygen saturation\u2009=\u200995%, respiratory rate\u2009=\u200916, temperature\u2009=\u200937\u00b0C. The patient venous blood gas analysis manifested severe metabolic acidosis (pH\u2009=\u20096.92, pO<jats:sub>2<\/jats:sub>\u2009=\u200943\u2009mmHg, HCO<jats:sub>3<\/jats:sub>\u2009=\u20098.6\u2009mmol\/L, pCO<jats:sub>2<\/jats:sub>\u2009=\u200942.7\u2009mmHg, base excess\u2009=\u2009\u221225.9\u2009mmol\/L). Four hours later, she became unconscious and she was intubated. Gastric lavage and a single dose of 60\u2009g of activated charcoal and sodium bicarbonate were administered. In the referral hospital, sodium nitrite was given due to the severity of the poisoning, and norepinephrine infusion was initiated to manage hypotension. Within a day, the patient regained consciousness, underwent extubation, and after 72\u2009h was discharged and subsequently transferred to psychiatric care for further treatment. This case underscores the critical, life\u2010threatening implications of cyanide toxicity following the ingestion of bitter almonds, highlighting the efficacy of supportive measures such as gastric lavage, activated charcoal, and sodium bicarbonate. Furthermore, it emphasizes the successful application of sodium nitrite monotherapy in managing this condition.<\/jats:p>","DOI":"10.1002\/ccr3.8418","type":"journal-article","created":{"date-parts":[[2024,1,9]],"date-time":"2024-01-09T05:39:51Z","timestamp":1704778791000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Cyanide poisoning after bitter almond ingestion: \u201cA rare case report\u201d"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-7855-9983","authenticated-orcid":false,"given":"Neda","family":"Arabizadeh","sequence":"first","affiliation":[{"name":"School of Medicine Islamic Azad University Najafabad Branch  Isfahan Iran"},{"name":"Clinical Toxicology Department, School of Medicine, Isfahan Clinical Toxicology Research Center Isfahan University of Medical Science  Isfahan Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masoud","family":"Mahmoudi","sequence":"additional","affiliation":[{"name":"Clinical Toxicology Department, School of Medicine, Isfahan Clinical Toxicology Research Center Isfahan University of Medical Science  Isfahan Iran"},{"name":"School of Medicine Isfahan University of Medical Science  Isfahan Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laaya Mokhtar","family":"Gandomani","sequence":"additional","affiliation":[{"name":"Clinical Toxicology Department, School of Medicine, Isfahan Clinical Toxicology Research Center Isfahan University of Medical Science  Isfahan Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9792-8160","authenticated-orcid":false,"given":"Nastaran","family":"Eizadi\u2010Mood","sequence":"additional","affiliation":[{"name":"Clinical Toxicology Department, School of Medicine, Isfahan Clinical Toxicology Research Center Isfahan University of Medical Science  Isfahan Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,1,8]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.4103\/0019-5049.135045"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/610648"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13181-018-0688-y"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.5487\/TR.2012.28.3.195"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/15563650.2022.2080074"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/15563650.2018.1435886"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.4081\/ecj.2019.8256"},{"issue":"1","key":"e_1_2_10_9_1","first-page":"65","article-title":"Cyanide poisoning after bitter almond ingestion","volume":"136","author":"Shragg TA","year":"1982","journal-title":"West J 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