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ACMT Toxicology Visual Pearls: Discolored Skin and Urine


cyanide poisoning cyanide poisoning

A patient is brought to the Emergency Department by EMS (Emergency Medical Services) from a house fire. The patient’s skin and urine are discolored as shown. What is the most likely cause of the discoloration?

  1. Acute liver failure
  2. An antidote administered by prehospital provider
  3. Carbon monoxide poisoning
  4. Massive hemolysis

Reveal the Answer

This post was peer-reviewed by Dr. Vikhyat Bebarta, Dr. Bryan Judge, and Dr. Louise Kao.

The American College of Medical Toxicology (ACMT) hosts this Toxicology Visual Pearls series
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Baud F, Barriot P, Toffis V, et al. Elevated blood cyanide concentrations in victims of smoke inhalation. N Engl J Med. 1991;325(25):1761-1766. [PubMed]
MacLennan L, Moiemen N. Management of cyanide toxicity in patients with burns. Burns. 2015;41(1):18-24. [PubMed]
Hall A, Rumack B. Clinical toxicology of cyanide. Ann Emerg Med. 1986;15(9):1067-1074. [PubMed]
Nithiodote (R). [Prescribing Information]. Scottsdale, AZ:Hope Pharmaceuticals; 2011:0.
Cyanokit (R). [Package Insert]. Columbia, MD: Meridian Medical Technologies; 2011:0.
Bebarta V, Pitotti R, Dixon P, et al. Hydroxocobalamin and epinephrine both improve survival in a swine model of cyanide-induced cardiac arrest. Ann Emerg Med. 2012;60(4):415-422. [PubMed]
Hannah Malashock, MD

Hannah Malashock, MD

Medical Toxicology Fellow Department of Medical Toxicology University of Arizona College of Medicine- Phoenix
Hannah Malashock, MD

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