OBJECTIVE: Cyanide poisoning is a rare but life-threatening medical emergency that requires prompt recognition and intervention. The absence of specific signs and symptoms makes diagnosis challenging. This report highlights a case of cyanide poisoning following a suicide attempt and emphasizes the importance of a comprehensive approach to treatment, including the administration of hydroxocobalamin.

CASE: A 45-year-old man was admitted to the Emergency Department following a cyanide ingestion suicide attempt. He presented with seizures, severe metabolic acidosis, altered mental status, and hemodynamic instability. Initial management involved rapid seizure control with midazolam, intubation to secure the airway, and arterial blood gas analysis, revealing profound acidosis.

Despite aggressive supportive care, the patient continued to experience seizures and required positive inotropic support due to persistent hypotension. Key information regarding cyanide ingestion was obtained from the patient's relatives, prompting the administration of hydroxocobalamin (Cyanokit) as the specific antidote. Cyanokit, containing 5 grams of hydroxocobalamin, was administered intravenously over 30 minutes. Within minutes of initiation, a characteristic reddish-pink coloration was observed in the patient's skin and urine. Subsequent arterial blood gas analysis demonstrated a remarkable improvement in acid-base parameters, confirming the antidote's efficacy.

RESULT: Cyanide poisoning is a rare but highly lethal medical emergency. The absence of pathognomonic signs necessitates a high index of suspicion among healthcare providers. Prompt recognition and initiation of specific antidote treatment are paramount to reducing morbidity and mortality in cyanide poisoning cases. The availability of effective antidotes, such as Cyanokit (hydroxocobalamin), has improved patient outcomes while minimizing severe side effects. This case underscores the importance of increased awareness of cyanide poisoning and its potential treatments in emergency medical practice.