Laboratory Evaluation

In order to be effective, treatment of cyanide poisoning must be instituted long before confirmatory laboratory studies can be accomplished. Cyanide levels are useful to confirm a clinical diagnosis in retrospect or for forensic purposes. They cannot be obtained in time to make the diagnosis at the bedside. Because cyanide is sequestered in erythrocytes, erythrocyte and plasma cyanide levels should be obtained. Whole-blood cyanide levels are not useful. Cyanide levels do not correlate well with toxicity but will support a diagnosis. Normal erythrocyte cyanide levels are less than 1.9 p MIL (50 pgIL), while death from cyanide is associated with erythrocyte levels greater than 40 p MIL (1 mgIL). Toxicity is seen with serum cyanide levels ranging from 0.5 mgIL (anxiety, confusion, tachypnea) to more than 3 mgIL (apnea, cardiovascular collaspse).6 The arterial blood gas is a rapid and useful test, as noted earlier. The absence of a metabolic acidosis is inconsistent with the diagnosis of acute cyanide poisoning (Xab[e..,.182.-2). Recently, the demonstration of a serum lactate level greater than 10 m MIL was shown to have a significant correlation with toxic cyanide levels in victims of smoke inhalation.8 The measurement of carboxyhemoglobin levels by use of a cooximeter is important in the assessment of smoke inhalation victims. Table 18.2-2. summarizes laboratory findings anticipated in cyanide poisoning.

Free Yourself from Panic Attacks

Free Yourself from Panic Attacks

With all the stresses and strains of modern living, panic attacks are become a common problem for many people. Panic attacks occur when the pressure we are living under starts to creep up and overwhelm us. Often it's a result of running on the treadmill of life and forgetting to watch the signs and symptoms of the effects of excessive stress on our bodies. Thankfully panic attacks are very treatable. Often it is just a matter of learning to recognize the symptoms and learn simple but effective techniques that help you release yourself from the crippling effects a panic attack can bring.

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