A case of cyanide poisoning complicated with carbon monoxide poisoning caused by smoke inhalation

Patient management after fires in confined spaces is often complicated by carbon monoxide (CO) poisoning and burn injuries. Furthermore, some patients develop cyanide poisoning due to hydrogen cyanide inhalation. In this study, we report a patient with cyanide and CO poisoning in whom we could measure the blood cyanide concentration. An 18-year-old man was admitted to our hospital after being recovered by a fire fighter following a fire at a bar. On admission, his Glasgow Coma Scale score was 3, and he had burns to 12% of his body surface area, including his face and hands. His blood lactate and carboxyhemoglobin levels were 13.5 mmol/L and 33.8%, respectively. Blood cyanide concentration 1 hour after admission was 4.3 µg/mL. Hydroxocobalamin as an antidote to cyanide poisoning was not administered to the patient because the drug was not prepared in our hospital. Computed tomog-raphy of the head performed 3 days after admission revealed severe brain edema and loss of the border between the cerebral cortex and the medulla. He died 6 days after his presentation, and the cause of death seemed to be hypoxic encephalopathy. Thus, hydroxocobalamin should always be available in patients who have been injured during fires in confined spaces.