Cyanide Toxicity Differential Diagnoses

  • Author: Inna Leybell, MD; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Nov 1, 2011
 
 

Diagnostic Considerations

Multiple casualties may present after a fire or hazardous materials incident involving cyanides. In some cases, the individuals involved may be experiencing collective hysteria. If physical findings are absent, cyanide poisoning is unlikely. If lactic acidosis is not present, cyanide poisoning has not occurred. Provide supportive care (oxygen) to all individuals presenting because of the event until absence of cyanide poisoning can be verified.

The following conditions can be considered in the differential diagnosis of cyanide toxicity:

  • Acute coronary syndrome
  • Anaphylaxis
  • Angina pectoris
  • Myocardial infarction
  • Apnea
  • Gastroenteritis
  • Headache
  • Meningitis and encephalitis
  • Tachycardia
  • Hemlock poisoning
  • Pulmonary embolism
  • Cardiogenic shock
  • Ischemic stroke
  • Carbon monoxide toxicity
  • Hydrogen sulfide toxicity
  • Iron toxicity
  • Isoniazid toxicity
  • Nonsteroidal anti-inflammatory agent toxicity
  • Azide toxicity
  • Methanol toxicity
  • Strychnine toxicity

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Inna Leybell, MD  Clinical Assistant Professor, Department of Emergency Medicine, NYU Langone Medical Center

Inna Leybell, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Student Association/Foundation, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

Stephen W Borron, MD, MS, FAAEM, FACEP, FAACT, FACMT  Professor of Emergency Medicine and Medical Toxicology, Division of Medical Toxicology, Department of Emergency Medicine, Paul L Foster School of Medicine, Texas Tech University Health Sciences Center; Associate Medical Director, West Texas Regional Poison Center

Stephen W Borron, MD, MS, FAAEM, FACEP, FAACT, FACMT is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, American College of Occupational and Environmental Medicine, American Industrial Hygiene Association, and European Association of Poisons Centres and Clinical Toxicologists

Disclosure: Meridian Pharmaceuticals Consulting fee Consulting

Carlos J Roldan, MD, FAAEM  Assistant Professor, Department of Emergency Medicine, University of Texas Health Science Center at Houston Medical School; Consulting Staff, Department of Emergency Medicine, Memorial Hermann Hospital and Lyndon Baines General Hospital

Carlos J Roldan, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Pain Society, American Society of Regional Anesthesia and Pain Medicine, International Association for the Study of Pain, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

Additional Contributors

Frederic J Baud, MD Director, Professor, Toxicological and Medical Intensive Care Unit, Hôpital Lariboisiere of Paris, France

Disclosure: Nothing to disclose.

John G Benitez, MD, MPH, FACMT, FAACT, FACPM, FAAEM, Associate Professor, Department of Medicine, Medical Toxicology, Vanderbilt University Medical Center; Managing Director, Tennessee Poison Center

John G Benitez, MD, MPH, FACMT, FAACT, FACPM, FAAEM, is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Medical Toxicology, American College of Preventive Medicine, Society for Academic Emergency Medicine, Undersea and Hyperbaric Medical Society, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Robert S Hoffman, MD, FAACT, FACMT Associate Professor, Departments of Emergency Medicine and Medicine, Clinical Pharmacology, New York University School of Medicine, Consulting Staff, Department of Emergency Services, Bellevue and New York University Hospital

Robert S Hoffman, MD, FAACT, FACMT is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, American College of Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

David C Lee, MD Research Director, Department of Emergency Medicine, Associate Professor, North Shore University Hospital and New York University Medical School

David C Lee, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart & St. Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

References

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  2. National Cancer Institute. Cancer topics: Laetrile/Amygdalin. 11/21/2005;[Full Text].

  3. Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Heard SE. 2007 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 25th Annual Report. Clin Toxicol (Phila). Dec 2008;46(10):927-1057. [Medline]. [Full Text].

  4. Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Giffin SL. 2008 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 26th Annual Report. Clin Toxicol (Phila). Dec 2009;47(10):911-1084. [Medline].

  5. Lee J, Mukai D, Kreuter K, et al. Potential interference by hydroxocobalamin on co-oximetry hemoglobin measurements during cyanide and smoke inhalation treatments. Ann Emerg Med. 2007;49(6):802-805. [Medline].

  6. Fortin JL, Desmettre T, Manzon C, Judic-Peureux V, Peugeot-Mortier C, Giocanti JP, et al. Cyanide poisoning and cardiac disorders: 161 cases. J Emerg Med. May 2010;38(4):467-76. [Medline].

  7. Borron SW, Baud FJ, Mégarbane B, Bismuth C. Hydroxocobalamin for severe acute cyanide poisoning by ingestion or inhalation. Am J Emerg Med. Jun 2007;25(5):551-8. [Medline].

  8. Borron SW, Baud FJ, Barriot P, Imbert M, Bismuth C. Prospective study of hydroxocobalamin for acute cyanide poisoning in smoke inhalation. Ann Emerg Med. Jun 2007;49(6):794-801, 801.e1-2. [Medline].

  9. Bebarta VS, Tanen DA, Lairet J, Dixon PS, Valtier S, Bush A. Hydroxocobalamin and sodium thiosulfate versus sodium nitrite and sodium thiosulfate in the treatment of acute cyanide toxicity in a swine (Sus scrofa) model. Ann Emerg Med. 2010;55(4):345-51. [Medline].

  10. Curry SC, Connor DA, Raschke RA. Effect of the cyanide antidote hydroxocobalamin on commonly ordered serum chemistry studies. Ann Emerg Med. Jul 1994;24(1):65-7. [Medline].

  11. Sutter M, Tereshchenko N, Rafii R, Daubert GP. Hemodialysis Complications of Hydroxocobalamin: A Case Report. J Med Toxicol. Mar 30 2010;[Medline].

  12. Hall AH, Saiers J, Baud F. Which cyanide antidote?. Crit Rev Toxicol. 2009;39(7):541-52. [Medline].

 
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