{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T03:47:43Z","timestamp":1788925663650,"version":"build-2803163510"},"reference-count":16,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2017,7,6]]},"abstract":"<jats:p>Hypoxia under general anaesthesia is a potentially life-threatening condition. A seemingly well 67-year-old man appeared hypoxic with peripheral pulse oximetric measurement during routine anaesthesia. Postoperatively, the patient admitted to daily self-prescription of apricot kernel extract for a period of 5 years. Apricot kernel is a commonly taken extract used for a range of ailments, and is associated with cyanide toxicity, which was confirmed through blood analysis. Our explanation for the hypoxic measurement was the presence of free cyanide interfering with functioning of the peripheral pulse oximeter. On cessation of the apricot kernel extract, peripheral oxygen saturations returned to normal. Cardiac and respiratory causes together with rare haemoglobinopathies were excluded. This case illustrates how chronic dosing of complementary medicines can result in harmful toxicities, which may carry potential for serious consequences and how these chronic toxicities may present to physicians in atypical ways.<\/jats:p>","DOI":"10.1136\/bcr-2017-220814","type":"journal-article","created":{"date-parts":[[2017,9,11]],"date-time":"2017-09-11T18:50:20Z","timestamp":1505155820000},"page":"bcr-2017-220814","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["An unusual presentation of chronic cyanide toxicity from self-prescribed apricot kernel extract"],"prefix":"10.1136","volume":"2017","author":[{"given":"Alex","family":"Konstantatos","sequence":"first","affiliation":[{"name":"Departments of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malini","family":"Shiv Kumar","sequence":"additional","affiliation":[{"name":"Departments of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aidan","family":"Burrell","sequence":"additional","affiliation":[{"name":"Departments of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel","family":"Smith","sequence":"additional","affiliation":[{"name":"Departments of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,9,11]]},"reference":[{"key":"2025082706491797000_2017.sep11_1.bcr-2017-220814.1","doi-asserted-by":"publisher","DOI":"10.1054\/ctim.2000.0407"},{"key":"2025082706491797000_2017.sep11_1.bcr-2017-220814.2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2125.2003.01810.x"},{"key":"2025082706491797000_2017.sep11_1.bcr-2017-220814.3","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2125.2003.01811.x"},{"key":"2025082706491797000_2017.sep11_1.bcr-2017-220814.4","doi-asserted-by":"publisher","DOI":"10.1136\/bcr.03.2011.3932"},{"key":"2025082706491797000_2017.sep11_1.bcr-2017-220814.5","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1E634"},{"key":"2025082706491797000_2017.sep11_1.bcr-2017-220814.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(98)70077-0"},{"key":"2025082706491797000_2017.sep11_1.bcr-2017-220814.7","unstructured":"Sale of raw apricot kernels prohibited. Fodstuffs.gov.au. 2016."},{"key":"2025082706491797000_2017.sep11_1.bcr-2017-220814.8","unstructured":"The National Archives. Agency alerts consumers about possible risk from eating bitterapricot kernels. 2006. www.food.gov.uk\/news\/newsarchive\/2006\/apr\/apricot"},{"key":"2025082706491797000_2017.sep11_1.bcr-2017-220814.9","unstructured":"Health Canada. Advisories and Warnings. 2009. http:\/\/www.hc-sc.gc.ca\/ahc-asc\/media\/advisories-avis\/_2009\/2009_101-eng.php; http:\/\/www.healthycanadians.gc.ca\/recall-alert-rappel-avis\/hc-sc\/2009\/13308a-eng.php"},{"key":"2025082706491797000_2017.sep11_1.bcr-2017-220814.10","doi-asserted-by":"publisher","DOI":"10.3109\/15563658408992565"},{"key":"2025082706491797000_2017.sep11_1.bcr-2017-220814.11","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(98)70077-0"},{"key":"2025082706491797000_2017.sep11_1.bcr-2017-220814.12","doi-asserted-by":"publisher","DOI":"10.1248\/jhs.46.343"},{"key":"2025082706491797000_2017.sep11_1.bcr-2017-220814.13","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/S0022-3565(25)33013-2","article-title":"The role of erythrocytes in cyanide detoxification","volume":"221","author":"McMillan","year":"1982","journal-title":"J Pharmacol Exp Ther"},{"key":"2025082706491797000_2017.sep11_1.bcr-2017-220814.14","unstructured":"Trefor F , Ernest B , Basil TD . Hemoglobin, Iron and Bilirubin. In: Burtis CA , Ashwood ER , Burns DE , eds. Tietz textbook\u00a0of clinical chemistry and molecular diagnostics. 5th edn:985\u20137. http:\/\/www.foodstandards.gov.au\/media\/Pages\/Sale-of-raw-apricot-kernels-"},{"key":"2025082706491797000_2017.sep11_1.bcr-2017-220814.15","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1002\/ajh.22074","article-title":"Erratum to: unexpectedly low pulse oximetry measurements associated with variant hemoglobins: a systematic review","volume":"86","author":"Verhovsek","year":"2011","journal-title":"Am J Hematol"},{"key":"2025082706491797000_2017.sep11_1.bcr-2017-220814.16","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-005-2797-8"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2017-220814","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T13:49:29Z","timestamp":1756302569000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2017-220814"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,9,11]]},"references-count":16,"alternative-id":["10.1136\/bcr-2017-220814"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2017-220814","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,9,11]]}}}