Cyanide: an unreported cause of neurological complications following smoke inhalation.
Although the combustion of natural and synthetic products can yield cyanide, its toxic role in residential fires is unclear. This case concerns a woman aged over 50 years who presented comatose, pulseless and apnoeic after a domestic fire. Cardiopulmonary resuscitation and on-site administration of 2.5 g hydroxocobalamin as an antidote to cyanide resulted in a return of spontaneous circulation. On admission to the intensive care unit, the patient was treated with hyperbaric oxygen for suspected carbon monoxide poisoning. In a blood specimen collected at the scene before hydroxocobalamin administration, blood cyanide and carbon monoxide levels were 68 µmol/l and 10.9%. On admission to hospital, plasma lactate was at 4.6 mmol/l. Brain scans revealed lesions which were confirmed 2 months later, consistent with the haemorrhagic necrosis often seen after poisoning by cyanide. These data suggest that smoke inhalation in a residential fire may cause cyanide poisoning. This case provides clinical, biological, analytical and brain imaging data supporting the hypothesis of the toxic role of smoke-induced cyanide poisoning which may result in neurological sequelae.
Réanimation Médicale et Toxicologique, Hôpital Lariboisière, Paris, France. frederic.baud@lrb.aphp.fr
Frédéric
F
Baud
Monique
M
Boukobza
Stephen W
SW
Borron
D001927:Brain Diseases / Q000139:chemically induced*; D003486:Cyanides / Q000506:poisoning*; D005260:Female; D005390:Fires; D006801:Humans; D001239:Inhalation; D008875:Middle Aged; D012906:Smoke / Q000009:adverse effects*
D003486:Cyanides; D012906:Smoke