Cyanide poisoning after bitter almond ingestion

Plants are responsible for 5% poisoning recorded by Poison Control Centers. Among all known toxic plants, some present a real danger if ingested. We report the case of a five years old child, who presented, after ten bitter almonds ingestion, consciousness disorders progressing to coma with generalized tonic-clonic seizures, miosis and metabolic acidosis. Bitter almonds and nuclei of stone fruits or other rosaceae (apricot, peach, plum) contain cyanogenic glycosides, amygdalin, that yields hydrogen cyanide when metabolized in the body. Swallowing six to ten bitter almonds may cause serious poisoning, while the ingestion of fifty could kill a man. The binding of cyanide ions on cytochrome oxidase lead to a non hypoxemic hypoxia by blocking the cellular respiratory chain. Therapeutic measures include, oxygen support, correction of acidosis and cyanide antidote by hydroxocobalamin in case of serious poisoning.