Delayed presentation of nitroprusside-induced cyanide toxicity

Area of Science:

• Critical Care Medicine
• Cardiovascular Surgery
• Clinical Toxicology

Background:

• Sodium nitroprusside is a potent vasodilator used in critical care.
• Cyanide toxicity is a known but infrequent adverse effect of sodium nitroprusside infusion.
• Diagnosing cyanide toxicity in critically ill patients can be challenging due to overlapping symptoms.

Observation:

• A patient developed lactic acidosis following cardiac surgery.
• The lactic acidosis emerged after the discontinuation of sodium nitroprusside therapy.
• This presentation mimicked other common post-operative complications.

Findings:

• The patient's condition was attributed to cyanide toxicity secondary to sodium nitroprusside.
• Lactic acidosis served as a crucial indicator of cyanide poisoning in this context.
• Early recognition of this rare complication is vital for timely intervention.

Implications:

• This case underscores the importance of considering cyanide toxicity in critically ill patients receiving sodium nitroprusside.
• Enhanced diagnostic vigilance is required for this rare but serious adverse event.
• Clinical protocols may need to emphasize monitoring for cyanide toxicity signs post-nitroprusside discontinuation.