Case challenge · Emergency / Toxicology / Critical care · teaching

Cyanide Poisoning — Management Pathway · case challenge

Given a case, work through the care pathway step by step; the tool checks each choice and scores you. Decisions and basis are taken from this site's reviewed care pathways.

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Case #1Emergency / Toxicology / Critical care

📋 Case data

Antidote needed?Severe/high lactate/altered mentation/unstable

Data is taken from this pathway's reviewed node text. Work through the pathway step by step.

Step 1 / 1 · Antidote needed?

Fire/industrial exposure + lactate/acidosis — is an antidote needed?

💡 Inhibits cytochrome c oxidase → stops oxidative phosphorylation → cellular asphyxia → high lactate + high-anion-gap metabolic acidosis, narrowed arteriovenous oxygen difference (tissue cannot extract oxygen). Sources: enclosed-space fire smoke (most common), industrial/HCN, suicide, nitroprusside. Rapid onset (deterioration hours later is not cyanide); early hypertension/tachycardia → severe coma/seizures/bradycardia-hypotension/arrest. Lactate ≥8–10 suggests it, <8 excludes significant poisoning; in fire victims with altered mentation/instability assume cyanide (often with co-existing CO).

For teaching. Decisions and their basis are taken from this site's reviewed care pathways; for licensed clinicians/trainees, this does not replace clinical judgment or local protocols.