Diagnosis and Treatment of Cyanide Toxicity

The role of cyanide toxicity in victims of fire has been extensively examined in both the medical and the fire literature in the 1970s, 1980s, and 1990s. A large clinical series and comprehensive literature review was published in the burn literature in 1994.1 Since that time, several articles have revisited this issue,2,–12 in part prompted by the availability of a new cyanide antidote kit. The combustion of certain household furnishings can produce cyanide. Cyanide can be detected in trace amounts in the smoke at house fires13 and in the blood of both smokers and fire victims.14,–18 Ingestion of cyanide produces metabolic acidosis, an acid-base derangement also seen in burn patients during resuscitation. Proponents of the “cyanide poisoning” theory of smoke inhalation link these facts and draw the conclusion that fire victims need to be treated with cyanide antidotes.2,3,19,–22 Such studies do not consider the fire environment, the inherent inaccuracies in cyanide assay, the fact that cyanide is a normal human metabolite, the capability of the body to detoxify cyanide, or the evidence that cyanide can be produced in vitro by normal human blood and in situ in certain organs after death.23