A lactate > 8 mmol/L has a PPV of 64% and a NPV of 98% for CN concentrations above 1 mcg/mL – A good surrogate measure of CN concentrations is lactate. – CN levels are not readily available, but levels > 3 mcg/mL lead to death and lower levels can cause a spectrum of coma, reduced consciousness, and/ or tachycardia – Sign/symptoms include agitation, confusion, seizures, coma, and respiratory/ cardiovascular collapse – CN acts as a “chemical asphyxiant” by inhibiting cytochrome oxidase, which is essential for aerobic energy production. In acute poisoning the rate-limiting step of rhodanese is the availability of sulfur donors – CN is typically eliminated through the conversion to thiocyanate by the rhodanese enzyme.
– Cyanide (CN) toxicity is most commonly associated with smoke inhalation
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