Podcast 574: Cyanide Toxicity

Significant cyanide exposure most commonly occurs from fire/smoke exposure particularly when plastics are involved

Cyanide binds to cytochrome oxidase leading to the use of anaerobic metabolism which causes a profound lactic acidosis

Classic toxicity includes a rapid loss of consciousness, hypotension, bradycardia, respiratory depression, and seizures

Mild exposures can lead to nausea/vomiting, headaches, and other nonspecific symptoms.

Sometimes patients will complain of an almond taste.

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)

Antidote is hydroxocobalamin and sodium thiosulfate

Severe cyanide exposure will likely need ICU level care until the blood gas levels return to their baselines and the lactic acidosis resolves