Podcast 574:  Cyanide Toxicity

<p><strong>Contributor: Nick Tsipis, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;"><span style= "font-weight: 400;">Significant cyanide exposure most commonly occurs from fire/smoke exposure particularly when plastics are involved</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Cyanide binds to cytochrome oxidase leading to the use of anaerobic metabolism which causes a profound lactic acidosis</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Classic toxicity includes a rapid loss of consciousness, hypotension, bradycardia, respiratory depression, and seizures</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">Mild exposures can lead to nausea/vomiting, headaches, and other nonspecific symptoms.</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Sometimes patients will complain of an almond taste.</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Cyanide toxicity will manifest on labs by a profound anion gap acidosis with elevated lactate (but don't wait for them to ponder the diagnosis)</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Antidote is hydroxocobalamin and sodium thiosulfate</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Severe cyanide exposure will likely need ICU level care until the blood gas levels return to their baselines and the lactic acidosis resolves</span></li> </ul> <p><strong>References</strong></p> <p><span style="font-weight: 400; font-size: 10pt;">Nickson Chris C, Australian Centre for Health Innovation at Alfred Health. Cyanide Poisoning • LITFL • CCC Toxicology. Life in the Fast Lane • LITFL • Medical Blog. https://litfl.com/cyanide-poisoning-ccc/. Published April 2, 2019. Accessed June 11, 2020.</span></p> <p><span style="font-size: 10pt;"><span style= "font-weight: 400;">Parker-Cote JL, Rizer J, Vakkalanka JP, Rege SV, Holstege CP. Challenges in the diagnosi