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.

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