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Description

Cyanide toxicity is an uncommon but highly lethal intoxication, most frequently associated with smoke inhalation yet increasingly accessible via online purchase of cyanide salts. Intentional ingestions constitute a minority of reported exposures, but delayed recognition is common because classic signs such as "bitter almond" odor and cherry-red skin are unreliable and confirmatory testing is not rapidly available in the emergency department.

A previously healthy 27-year-old man was found unresponsive at home after a presumed "knockdown" event, with emesis in the toilet and a history of prior suicide attempts and online chemical procurement including cyanide. He arrived to a community emergency department with a Glasgow Coma Scale of 3, profound metabolic and lactic acidosis, shock, and rapid progression to multi-vasopressor dependence, later developing fixed, dilated pupils and imaging consistent with diffuse anoxic brain injury.

This case illustrates the fulminant course and high mortality of acute cyanide ingestion, even with early aggressive resuscitation and appropriate antidotal therapy. Emergency clinicians must maintain a high index of suspicion for cyanide toxicity in patients with sudden cardiovascular collapse, severe lactic acidosis, and suggestive history, and be prepared to initiate empiric antidote treatment in the absence of timely confirmatory testing.

Publication Date

5-8-2026

Disciplines

Emergency Medicine

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1951

Rare but Rapidly Fatal: Acute Cyanide Ingestion Presenting as Refractory Vasodilatory Shock

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