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