Objective: Suicidal behavior defined as in favor of death, in dilemma of life and death. Lethal and non-lethal suicidal behaviors are quite a close relationship; and many people that killed himself have suicide attempts or the notion of self-harm in the past. Suicidal attempts with drug intoxications, organic phosphorus, corrosive substances, hanging, gunshot, jumping from high, cutting and penetrating stab are considered as serious suicidal attempts. Similarly, suicide attempts with cyanide take place in this group. In this report, we present a case of attempted suicide with subcutaneous injection of cyanide, which is an uncommon method.
Case: A 91-year-old male patient was evaluated in the emergency department due to attempted suicide, the patient has tried to inject potassium cyanide. A few hours after attempt, tissue swelling has occurred and the patient admitted to an emergency room. In psychiatric interview; its learned, the complaints of the patient were loneliness, saddieness, unhappiness, and thoughts of death. The patient was admitted to our clinic with a diagnosis of depressive disorder. In mental status examination; external appearance was observed to be compatible age and socio-economic level. The patient had thoughts of worthlessness due to disease. His affect was depressed. Person, place, and time orientation were normal. On physical examination; fever, pulse rate, blood pressure values were within normal limits. Blurred vision in his eyes. There is a hemorrhagic necrosis of tissue in size 3 cm x 5 cm in the inner side of the left forearm. In clinical follow-up; the liver enzymes slightly elevated in first three days. 15 mg/day doses of mirtazapine was started on fourth day and increased to 30 mg/day. Beck Depression Rating Scale score was 29, Hamilton Depression Rating Scale score was 17. Mini-mental test score was 29 points. in the second week, depressive symptoms decreased. The patient followed closely by the dermatology clinic. In the third week, the patient was discharged from clinic due to the general improvement in the psychiatric statement
Conclusion: Cyanide is fast-acting poison. Cyanide disrupts the cytochrome oxidase system and thus shows toxic effects in the body. As a result, a table of increased anion gap metabolic acidosis and normal PaO2 levels are occurs. The emergence of clinical signs of acute intoxication varies depending on route of the drug into the body, received cyanid type and concentration. Our case reported that chosen this suicide method to get the exact result and not to hurt anyone. In addition, the patient said that he applied injection method because if he take cyanide orally, it may impact on other people touching him. Our case is important because of showing that lethal methods of suicide attempt can occur in elderly patients with depression.