Cyanide poisoning from propionitrile exposure.

A 55-year-old worker was exposed to propionitrile by both the inhalational and dermal routes. He rapidly lost consciousness and developed metabolic acidosis consistent with cyanide poisoning. Treatment with hydroxycobalamin and sodium thiosulfate produced complete symptom resolution within an hour. Serial blood cyanide and thiocyanate levels documented a rapid decrease in cyanide and concomitant increase in thiocyanate. Serious cyanide poisoning can occur from propionitrile exposure. Treatment with hydroxycobalamin and sodium thiosulfate can produce rapid clinical improvement.