Acute cyanide poisoning by subcutaneous injection

Area of Science:

• Toxicology
• Emergency Medicine
• Critical Care

Background:

• Cyanide poisoning is a life-threatening condition often resulting from intentional ingestion or injection.
• Metabolic acidosis is a critical indicator of severe poisoning and systemic compromise.
• Prompt medical intervention is crucial for managing cyanide toxicity.

Observation:

• A 30-year-old female with a history of depression and suicide attempts presented in a coma.
• Subcutaneous self-injection of cyanide was identified as the cause of severe metabolic acidosis.
• The patient required intensive care unit (ICU) admission for sustained hemodialysis.

Findings:

• Laboratory confirmation revealed a serum cyanide concentration of 4.6 microg/ml.
• Sustained hemodialysis was effective in managing the severe metabolic acidosis and clearing the cyanide.
• The patient experienced a complete clinical recovery within 48 hours.

Implications:

• This case highlights the critical role of hemodialysis in managing severe cyanide poisoning.
• Early recognition and aggressive treatment can lead to favorable outcomes even in severe poisoning cases.
• Understanding routes of administration (subcutaneous) is important for toxicological assessments.