Key messages

• Although there are relatively few deaths attributed to cyanide each year, it is important to be able to make a rapid diagnosis in order to provide treatment for cure.

• As in any comatose patient, 100 per cent oxygen, glucose, thiamine, and naloxone should be given.

• When severe cyanide poisoning (coma, shock, ischemic ECG changes, or arrhythmias) is diagnosed, sodium thiosulfate should be administered followed by sodium nitrite if CO poisoning can be excluded.

• Other management approaches include artificial respiration, hyperbaric oxygen, vascular volume expansion, bicarbonate infusion, anticonvulsant drugs, and cardiovascular support.

• Long-term follow-up should occur in order to watch for signs of neurological deterioration and sequelae such as parkinsonian syndrome, myocardial damage, and goiter.

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