Abstract
Three patients presented with painless bilateral visual failure due to tobacco amblyopia. The whole blood cyanide levels were raised above those predicted from their high tobacco consumption, approaching lethal levels reported from acute inhalation of cyanide. Each patient had an excessive alcohol intake with biochemical evidence of hepatic dysfunction, the elevated whole blood cyanide levels being attributed to the associated impairment of cyanide detoxification. In each case the improvement in visual acuities following abstinence and hydroxycobalamin therapy was accompanied by a reduction in the whole blood cyanide level to within the normal range. Serial measurements of whole blood cyanide, serum alcohol, and the detection of urinary nicotine provided valuable indices of the patient's subsequent compliance and clinical progress.
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- BOXER G. E., RICKARDS J. C. Studies on the metabolism of the carbon of cyanide and thiocyanate. Arch Biochem Biophys. 1952 Jul;39(1):7–26. doi: 10.1016/0003-9861(52)90256-7. [DOI] [PubMed] [Google Scholar]
- Chisholm I. A., Bronte-Stewart J., Foulds W. S. Hydroxocobalamin versus cyanocobalamin in the treatment of tobacco amblyopia. Lancet. 1967 Aug 26;2(7513):450–451. doi: 10.1016/s0140-6736(67)90860-4. [DOI] [PubMed] [Google Scholar]
- Chisholm I. A., Pettigrew A. R. Biochemical observations in toxic optic neuropathy. Trans Ophthalmol Soc U K. 1970;90:827–838. [PubMed] [Google Scholar]
- Clark C. J., Campbell D., Reid W. H. Blood carboxyhaemoglobin and cyanide levels in fire survivors. Lancet. 1981 Jun 20;1(8234):1332–1335. doi: 10.1016/s0140-6736(81)92516-2. [DOI] [PubMed] [Google Scholar]
- FIEDLER H., WOOD J. L. Specificity studies on the beta-mercaptopyruvate-cyanide transsulfuration system. J Biol Chem. 1956 Sep;222(1):387–397. [PubMed] [Google Scholar]
- FISHER M. Residual neuropathological changes in Canadians held prisoners of war by the Japanese; Strachan's disease. Can Serv Med J. 1955 Mar;11(3):157–199. [PubMed] [Google Scholar]
- Foulds W. S., Bronte-Stewart J. M., Chisholm I. A. Serum thiocyanate concentrations in tobacco amblyopia. Nature. 1968 May 11;218(5141):586–586. doi: 10.1038/218586a0. [DOI] [PubMed] [Google Scholar]
- HEATON J. M., McCORMICK A. J., FREEMAN A. G. Tobacco amblyopia: a clinical manifestation of vitamin-B12 deficiency. Lancet. 1958 Aug 9;2(7041):286–290. doi: 10.1016/s0140-6736(58)90156-9. [DOI] [PubMed] [Google Scholar]
- Pettigrew A. R., Fell G. S. Microdiffusion method for estimation of cyanide in whole blood and its application to the study of conversion of cyanide to thiocyanate. Clin Chem. 1973 May;19(5):466–471. [PubMed] [Google Scholar]
- Potts A. M. Tobacco amblyopia. Surv Ophthalmol. 1973 Mar-Apr;17(5):313–339. [PubMed] [Google Scholar]
- VICTOR M., MANCALL E. L., DREYFUS P. M. Deficiency amblyopia in the alcoholic patient. A clinicopathologic study. Arch Ophthalmol. 1960 Jul;64:1–33. doi: 10.1001/archopht.1960.01840010003001. [DOI] [PubMed] [Google Scholar]
- VICTOR M. TOBACCO-ALCOHOL AMBLYOPIA. A CRITIQUE OF CURRENT CONCEPTS OF THIS DISORDER, WITH SPECIAL REFERENCE TO THE ROLE OF NUTRITIONAL DEFICIENCY IN ITS CAUSATION. Arch Ophthalmol. 1963 Sep;70:313–318. doi: 10.1001/archopht.1963.00960050315006. [DOI] [PubMed] [Google Scholar]
- Valentour J. C., Aggarwal V., Sunshine I. Sensitive gas chromatographic determination of cyanide. Anal Chem. 1974 Jun;46(7):924–925. doi: 10.1021/ac60343a048. [DOI] [PubMed] [Google Scholar]
- Victor M., Dreyfus P. M. Tobacco-alcohol amblyopia. Further comments on its pathology. Arch Ophthalmol. 1965 Nov;74(5):649–657. doi: 10.1001/archopht.1965.00970040651011. [DOI] [PubMed] [Google Scholar]
- Wetherell H. R. The occurrence of cyanide in the blood of fire victims. J Forensic Sci. 1966 Apr;11(2):167–173. [PubMed] [Google Scholar]