What is the differential diagnosis in cyanide intoxication? And what are the key laboratory findings?
Cyanide toxicity is difficult to diagnose because of the typically nonspecific symptoms and the relative rarity of the condition. Cases of mild exposure may mimic migraine. More severe exposures may be confused with carbon monoxide poisoning. Other conditions with similar presentations include organic solvent exposure, drug intoxication, central nervous system infection, brain injury, hypoxia, electrolyte disturbances, hypoglycemia, and the post-ictal state. Patients with an unexplained deterioration of mental status should undergo arterial blood gas analysis. Cyanide causes a wide anion-gap metabolic acidosis. The classic acronym MUDPILES (methanol/metformin, uremia, diabetic ketoacidosis, paraldehyde/phenformin, iron/isoniazid, lactate, ethylene glycol, salicylates) reminds the clinician to look into other possible causes of this form of metabolic acidosis. Modifying the acronym to SCUMPILED would extend this memory aid to include cyanide. Other laboratory abnormalities include eleva
