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

Cyanide poisoning via the oral route is a remarkably rare entity in the United States. Though acute toxicity from this poison may present with classic signs and symptoms (smell of bitter almonds on breath and cherry-red skin), these signs are frequently not clinically observed in the intoxicated patient, making it low on the routine differential diagnosis leading to both diagnostic and therapeutic challenges for the bedside clinician. This is a case of a 17-yearold male with a history of depression who presented to the Emergency Room (ER) with altered mental status, abdominal pain, and emesis. A severely elevated and worrisome lactic acidosis triggered the ER’s septic shock bundle and algorithm, but further investigation ultimately led to the unifying diagnosis of intentional cyanide poisoning.

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

Critical Care Medicine ◽

10.1097/00003246-200209000-00015 ◽

2002 ◽

Vol 30 (9) ◽

pp. 2044-2050 ◽

Cited By ~ 126

Author(s):

Frédéric J. Baud ◽

Stephen W. Borron ◽

Bruno Mégarbane ◽

Hervé Trout ◽

Frédéric Lapostolle ◽

...

Keyword(s):

Lactic Acidosis ◽

Cyanide Poisoning

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Fatality from potassium gold cyanide poisoning

BMJ Case Reports ◽

10.1136/bcr-2019-229947 ◽

2019 ◽

Vol 12 (7) ◽

pp. e229947 ◽

Cited By ~ 1

Author(s):

Elizabeth Harmon ◽

Jacob Lebin ◽

David Murphy ◽

Bjorn Watsjold

Keyword(s):

Lactic Acidosis ◽

Potassium Cyanide ◽

Clinical Findings ◽

Rapid Decline ◽

Gold Cyanide ◽

Cyanide Poisoning ◽

Severe Lactic Acidosis ◽

Cyanide Toxicity ◽

Intentional Ingestion ◽

Antidotal Therapy

While potassium cyanide poisoning has been well described, the toxicity of potassium gold cyanide is less well understood. This case describes an 84-year-old man who presented after an intentional ingestion of 0.5–1 teaspoons of potassium gold cyanide. Despite antidotal therapy, the patient rapidly developed severe lactic acidosis, multiorgan dysfunction and ultimately expired. While the patient’s clinical findings were consistent with acute cyanide poisoning, a serum cyanide level was below the toxic threshold. Previous reports have suggested that gold toxicity may also contribute to the effects of potassium gold cyanide, and may have played a role in the patient’s rapid decline. In addition to treatment of cyanide toxicity, management of acute gold toxicity should also be considered in potassium gold cyanide ingestion.

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