Cyanide Intoxication During Burn Inhalational Trauma: The Silent Heroes Living Among us: Case Report

Abstract

Here we report the case of a 71 years old gentleman, an unsung hero, who in an attempt to save another life became a surviving victim of household fire. The inhalational injury to his lung in the form of dense black ash filling his lungs was managed using mechanical ventilation and repeat bronchoalveolar lavaging with saline during bronchoscopy. Emerging high anion gap lactic acidosis, with poor oxygen extraction, likely due to inhalational cyanide intoxication was managed using the hydroxocobalamin antidote and bypassing the emerging ATP deficit using creatine phosphate. The oxygen diffusion capacity of the lung during the injury was not overly compromised, increased D dimers suggested the development of microthrombi, singularly not explaining
the anaerobic cell respiratory phenotype. The rapidly increasing blood lactate levels, reflecting deviation of the oxidative phosphorylation toward
anaerobic glycolysis due to respiratory chain complex IV blockade by inhalational cyanide were promptly reversed using creatine phosphate to regenerate high energy ATP and to scavenge cyanide by binding to hydroxycobalamin.