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A case report of acute cyanide poisoning treated with lactate as an indicator
Mitsuko Suzuki1, Saki Takeda2, Kazuki Sugaya3,4,5
1Department of Regional Emergency Medicine, Fukushima Medical University, Fukushima, Japan.
Rationale:
Cyanide poisoning is a life-threatening condition that impairs cellular oxygen utilization, leading to lactic acidosis. However, serum cyanide levels are not readily available in clinical settings, making diagnosis and treatment monitoring difficult. In this report, we describe the treatment of a patient with severe cyanide poisoning using serum lactate levels as an indicator of the effectiveness of the treatment.
Patient Concerns:
A 70-year-old man with suspected cyanide poisoning was transported to the emergency department in an unconscious state approximately 45 minutes after poisoning.
Diagnoses:
Laboratory findings revealed severe lactic acidosis (pH 7.07) with a high lactate level (19.0 mmol/L) and hypertension. Based on his history and clinical presentation, cyanide poisoning was strongly suspected.
Interventions:
The patient received antidotes and supportive care, including high-concentration oxygen therapy and antihypertensive medication. Serum lactate levels and blood cyanide concentrations were periodically measured to monitor treatment response.
Outcomes:
The patient's consciousness improved with decreasing lactate levels, achieving full consciousness approximately 9 hours after poisoning. Finally, he was discharged from the intensive care unit without apparent sequelae and transferred to a psychiatric ward.
Lessons:
This case highlights the utility of serum lactate as an accessible biomarker for diagnosing cyanide poisoning and evaluating treatment efficacy. Given the unavailability of rapid cyanide assays in most clinical settings, serial lactate monitoring may aid in guiding therapeutic decisions.
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