- Cyanide inhibits oxidative phosphorylation, ATP production, and intracellular O2 use - all resulting in tissue level hypoxemia and acidosis
- Inhalation in smoke during industrial or house fires
- Industrial exposures (ie accidents at work)
- Purposefully overdose (suicide attempt)
- Intent to harm (poisoning, mass exposure via terrorist activities)
- Vary with severity and time from exposure
- Early/mild: fatigue, malaise, headache, dizziness, nausea, confusion, vomiting
- Later/more severe: dyspnea, more confusion, coma, syncope, seizures, death
- Tachycardia, tachypnea, confusion
- Cyanosis, bradycardia, hypotension, cardiovascular collapse, dilated pupils, non-responsiveness
- Cherry red skin and bitter almond smell relatively uncommon
- + anion gap metabolic acidosis with very high lactate level that's otherwise unexplained
- Elevated cyanide levels (test not readily available)