Arteriolization of venous blood gases: A clue to the diagnosis of cyanide poisoning

Johnson, Rudolph P.; Mellors, John W.

doi:10.1016/0736-4679(88)90014-5

Cited by 44 publications

(25 citation statements)

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“…They provide supporting evidence that a central venous oxygen saturation greater than 90 % is abnormal and likely indicates inhibition of oxygen utilization [82]. They suggest that when using the venous blood as a surrogate for cyanide poisoning, it should ideally be drawn from central blood, but as in their case, peripherally drawn blood may potentially be helpful [82].…”

Section: How High Should Venous Oxygen Content Be To Help Make the DImentioning

confidence: 99%

“…By inhibition of oxidative phosphorylation, cyanide prevents cellular oxygen utilization and increases venous oxygen content, often referred to as Barteriolization^ [81,82]. In multiple case reports, the presence of an elevated venous oxygen content, either from centrally or peripherally drawn blood and often done simultaneously with analysis of arterial blood oxygen content, has been used as a surrogate marker for cyanide poisoning [63,74,79,80,[82][83][84][85][86][87].…”

Section: Wouldn't Cyanide Poisoning Associated With Severementioning

confidence: 99%

“…In multiple case reports, the presence of an elevated venous oxygen content, either from centrally or peripherally drawn blood and often done simultaneously with analysis of arterial blood oxygen content, has been used as a surrogate marker for cyanide poisoning [63,74,79,80,[82][83][84][85][86][87]. Serial measurement of venous oxygenation has also been described to monitor the need for additional antidotal treatment [87], and analysis of venous oxygen content has been used in animal studies evaluating the efficacy of cyanide antidotes [88].…”

Section: Wouldn't Cyanide Poisoning Associated With Severementioning

confidence: 99%

“…In a case report of cyanide poisoning, Johnson and Mellors detail a patient with an elevated peripherally drawn venous oxygen content [82]. They provide supporting evidence that a central venous oxygen saturation greater than 90 % is abnormal and likely indicates inhibition of oxygen utilization [82].…”

Section: How High Should Venous Oxygen Content Be To Help Make the DImentioning

confidence: 99%

“…An elevated peripheral venous oxygen content has been reported in multiple case reports of cyanide poisoning [63,80,82]. However, it appears that using peripherally drawn blood for analysis of elevated venous oxygen content is not ideal.…”

Section: How High Should Venous Oxygen Content Be To Help Make the DImentioning

confidence: 99%

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A 28-year-old man was brought to the Emergency Department (ED) for evaluation of a depressed level of consciousness that developed while in jail. Sixteen hours previously, he had been arrested on charges of murder. The patient's mental status was reported as normal at the time of arrest, and it had remained so during several hours of interrogation and during the booking process at jail. Following interrogation, the patient was placed into a cell with no other inmates. During the jail intake process, the patient had not reported any history of medical problems nor was he prescribed with any medications. Paramedics arrived to find him unresponsive, but maintaining airway reflexes and hemodynamically stable. They measured a blood glucose of 300 mg/dL and noted one episode of blood-tinged emesis during transport to the ED. No seizure activity was witnessed.On arrival to the ED, vital signs were: heart rate 132/min, blood pressure 129/74 mmHg, temperature 35.3°C (95.5°F), respiratory rate 24/min, and 100 % oxygen saturation on 15 l/ min of oxygen delivered by non-rebreather face mask.Physical examination was notable for a depressed level of consciousness. His eyes remained closed to pain, he withdrew all extremities equally to pain, and he was non-verbal. He had no signs of trauma, and his pupils were normal in size and reactive. Rapid sequence tracheal intubation was performed for airway protection. An electrocardiogram was normal except for sinus tachycardia at a rate of 111/min. An initial peripherally drawn arterial blood gas obtained immediately after intubation revealed: pH 6.97, pCO 2 40 mmHg, pO 2 215 mmHg. A computed tomography scan of the brain was normal. Initial blood chemistry panel was significant for a serum bicarbonate of 7 mEq/L, glucose of 362 mg/dL, and a normal potassium, blood urea nitrogen (BUN), creatinine, and calcium. The initial serum anion gap was 34 mEq/L. Measured serum osmolality was 320 mOsm/kg, yielding an osmol gap of 9 mOsm/kg (using formula of [2(Na)+BUN/2.8+glu-cose/18] for calculated serum osmolarity). Initial lactate was 156.5 mg/dL (normal reference range 4.5-19.8 mg/dL) and beta-hydroxybutyrate (βHB) 2.9 mg/dL (normal reference range 0.0-2.8 mg/dL). Initial liver panel included an aspartate aminotransferase (AST) of 64 U/L, alanine aminotransferase (ALT) of 27 U/L, and bilirubin of 0.4 mg/dL. Prothrombin time was 13.1 s (reference range 9.7-12.5), and lipase was normal at 25 U/L. Initial creatinine phosphokinase (CK) was slightly elevated at 373 U/L (0-175). Urinalysis was positive for small ketones and crystals were not present. Measurements of acetone and acetoacetate were not performed. Serum ethanol and salicylate levels were undetectable, and a urine drug of abuse panel by immunoassay was negative for amphetamines as a class, barbiturates as a class, benzodiazepines as a class, benzoylecgonine (cocaine metabolite), methadone, opiates as class, oxycodone, phencyclidine, and tetrahydrocannabinoids. Iron concentration was normal at 87 mcg/dL.Over the first hour of management,...

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Section: How High Should Venous Oxygen Content Be To Help Make the DImentioning

confidence: 99%