Value of lactic acidosis in the assessment of the severity of acute cyanide poisoning

Baud, Frédéric J.; Borron, Stephen W.; Mégarbane, Bruno; Trout, Hugh H.; Lapostolle, Frédéric; Vicaut, Éric; Debray, Marcel; Bismuth, C

doi:10.1097/00003246-200209000-00015

Cited by 169 publications

(91 citation statements)

References 39 publications

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“…Many patients poisoned with cyanide do not manifest hypotension despite having a depressed level of consciousness or coma [63,[68][69][70][71][72][73][74][75][76]. However, hypotension generally occurs in more severely poisoned patients and appears to correlate with a lower serum pH [64-66, 70, 74-79].…”

Section: Wouldn't Cyanide Poisoning Associated With Severementioning

confidence: 99%

“…However, hypotension generally occurs in more severely poisoned patients and appears to correlate with a lower serum pH [64-66, 70, 74-79]. In a series of patients poisoned with cyanide, Baud et al detailed that plasma lactate concentrations correlated positively with blood cyanide concentrations and inversely with systolic blood pressure and arterial pH [75]. In Baud's study, hypotension was present in multiple patients even though none had a pH less than 7.10 [75].…”

Section: Wouldn't Cyanide Poisoning Associated With Severementioning

confidence: 99%

“…In a series of patients poisoned with cyanide, Baud et al detailed that plasma lactate concentrations correlated positively with blood cyanide concentrations and inversely with systolic blood pressure and arterial pH [75]. In Baud's study, hypotension was present in multiple patients even though none had a pH less than 7.10 [75]. Hypotension typically appears in cases where the pH is less than 7.1 and/or the serum bicarbonate is less than 10 [64-66, 70, 74-79].…”

Section: Wouldn't Cyanide Poisoning Associated With Severementioning

confidence: 99%

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Case Files from the University of California San Diego Health System Fellowship Coma and Severe Acidosis: Remember to Consider Acetaminophen

Villano

O'Connell

et al. 2015

J. Med. Toxicol.

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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: Wouldn't Cyanide Poisoning Associated With Severementioning

confidence: 99%

Section: Wouldn't Cyanide Poisoning Associated With Severementioning

confidence: 99%

Section: Wouldn't Cyanide Poisoning Associated With Severementioning

confidence: 99%

See 1 more Smart Citation

Case Files from the University of California San Diego Health System Fellowship Coma and Severe Acidosis: Remember to Consider Acetaminophen

Villano

O'Connell

et al. 2015

J. Med. Toxicol.

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“…There is a significant correlation between blood cyanide concentrations and venous lactate in fire victims as shown by Baud et al [2,3] Lactate concentrations above 10 mmol/L are a sensitive indicator of cyanide poisoning in these specific conditions. More recently, a group of European experts has proposed emergency management protocols for cyanide toxicity in smoke inhalation victims using serial lactate measurements [4].…”

mentioning

confidence: 93%

One Poisoning Can Hide Another

T¹

2013

Emergency Medicine

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“…Indeed, cyanide very rapidly penetrates the cells and binds to the cytochrome c oxidase, resulting in inhibition of mitochondrial respiration and ATP formation. This promotes diffuse tissue hypoxia, metabolic acidosis and increased plasma lactate [1]. Management of severe cyanide intoxication includes: 1) supportive therapy with pure oxygen administration, invasive mechanical ventilation if comatose state or status epilepticus, cardiovascular support and bicarbonate infusion, and 2) antidotes, which should be administered immediately to reverse the combination of cyanide with the cytochrome oxidase.…”

Section: Introductionmentioning

confidence: 99%

Pink skin, urine and effluent fluid after cyanide poisoning

Debord¹,

Bourdin²,

Stoian³

et al. 2013

J Med Disord

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We are reporting a fatal case of cyanide intoxication due to voluntary ingestion treated by hydroxycobalamin as antidote. Twelve hours after ICU admission abnormal pink colored skin and urines were observed. The effluent fluid removed during the continuous veno-venous hemofiltration treatment also exhibited pink colour. Even though pink coloured skin and urines is a well-known side-effect of the hydroxycobalamin use as an antidote for cyanide, such an abnormal colour of the effluent fluid has not been previously reported. Contrary to what has been described with the haemodialysis machines whose functioning may be impaired by hydroxycobalamin, the device used to perform continuous renal replacement therapy has worked properly in present case. Therefore, continuous renal replacement therapy should be the first choice method if needed in this setting.

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Value of lactic acidosis in the assessment of the severity of acute cyanide poisoning

Abstract: The immediate and serial measurement of plasma lactate concentrations is useful in assessing the severity of cyanide poisoning.

Cited by 169 publications

References 39 publications

Case Files from the University of California San Diego Health System Fellowship Coma and Severe Acidosis: Remember to Consider Acetaminophen

Case Files from the University of California San Diego Health System Fellowship Coma and Severe Acidosis: Remember to Consider Acetaminophen

One Poisoning Can Hide Another

Pink skin, urine and effluent fluid after cyanide poisoning

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