title: High Anion Gap Metabolic Acidosis after a Suicide Attempt with Cyanide: The Rebirth of Cyanide Poisoning.
abstract: A 33-year-old woman was admitted to our emergency department in a state of unconsciousness after attempting suicide with unknown substances. Severe metabolic acidosis (pH: 6.81), with a high anion gap (36.2) and high lactate level (20.2 mmol/L), was observed. After four hours of intensive medical treatment, the patient regained consciousness, with a return of the arterial pH to 7.42. Finally, cyanide intoxication was diagnosed based on the detection of a serum cyanide level of 3.5 mg/L. The presence of a high anion gap associated with severe lactic acidosis is a clue for making a rapid differential diagnosis of acute cyanide intoxication. Providing intensive and immediate supportive management is also crucial, even in cases without obtainable specific antidotes.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan.
authors.forename: Po-Jen
authors.initials: PJ
authors.lastname: Hsiao
authors.forename: Che-Fu
authors.initials: CF
authors.lastname: Chang
authors.forename: Chih-Chien
authors.initials: CC
authors.lastname: Chiu
authors.forename: Jenq-Shyong
authors.initials: JS
authors.lastname: Chan
authors.forename: Wen-Fang
authors.initials: WF
authors.lastname: Chiang
authors.forename: Chia-Chao
authors.initials: CC
authors.lastname: Wu
authors.forename: Shih-Hua
authors.initials: SH
authors.lastname: Lin
authors.forename: Jin-Shuen
authors.initials: JS
authors.lastname: Chen
mesh_terms: D000136:Acid-Base Equilibrium; D000138:Acidosis / Q000139:chemically induced* / Q000628:therapy; D000328:Adult; D003486:Cyanides / Q000506:poisoning*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D013406:Suicide, Attempted; D014474:Unconsciousness
chemical_list: D003486:Cyanides