Cyanide Poisoning

WHAT IS IT?

Cyanide poisoning is a very self descriptive condition. 

WHAT CAUSES IT?

There are a few different causes of cyanide poisoning:

• Iatrogenic: nitroprusside is metabolized in the body to release nitric oxide and cyanide ions. Its excessive administration can lead to cyanide poisoning. 

WHY IS IT CONCERNING MEDICALLY?

Cyanide is a potent mitochondrial toxin: it binds to cytochrome c oxidase, and inhibits the electron transport chain. It brings aerobic respiration to a hill in the affected cell. 

WHAT IS THE INTIAL PRESENTATION?

Patient Chief Complaints:

• Altered mental status 
• Seizures 

Detected Medical Problems:

• Metabolic acidosis 

WHAT ARE IMPORTANT ELEMENTS OF THE MEDICAL HISTORY?

Risk Factors:

Medical History:

WHAT ARE IMPORTANT FEATURES OF THE PHYSICAL EXAM?

Vital Signs:

Other:

CLINICAL WORKUP: SERUM STUDIES

CLINICAL WORKUP: IMAGING

CLINICAL WORKUP: OTHER

HOW DO WE NARROW THE DIFFERENTIAL?

Conditions that present similarly and how to exclude them:

WHAT IS OUR THRESHOLD FOR DIAGNOSING THIS CONDITION?

PATIENT MANAGMENT: SYMPTOM RELEIF

PATIENT MANAGEMENT: DISEASE TREATMENT

Sodium nitrite: promotes methemoglobin formation, which combines with cyanide to form cyanmethemoglobin

Sodium thiosulfate: sulfur donor to promot ehepatic rhodanese-mediated conversion of cyanide to thiocyanate. Thiocyanate is excreted in the urine. 

Hydroxocobalamin: binds to intracellular cyanide inos, and forms cyanocobalamin which is removed in the urine. 

PATIENT MANAGEMENT: PROPHYLACTIC MEASURES

COULD THIS HAVE BEEN PREVENTED?

ARCHIVE OF STANDARDIZED EXAM QUESTIONS 

This archive compiles standardized exam questions that relate to this topic.

Page Updated: 04.10.2017