@article{ref1,
title="High anion gap metabolic acidosis after a suicide attempt with cyanide: the rebirth of cyanide poisoning",
journal="Internal medicine",
year="2015",
author="Hsiao, Po-Jen and Chang, Che-Fu and Chiu, Chih-Chien and Chan, Jenq-Shyong and Chiang, Wen-Fang and Wu, Chia-Chao and Lin, Shih-Hua and Chen, Jin-Shuen",
volume="54",
number="15",
pages="1901-1904",
abstract="A 33-year-old woman was admitted to our emergency department in a state of unconsciousness after attempting suicide with unknown substances. Severe metabolic acidosis (pH: 6.81), with a high anion gap (36.2) and high lactate level (20.2 mmol/L), was observed. After four hours of intensive medical treatment, the patient regained consciousness, with a return of the arterial pH to 7.42. Finally, cyanide intoxication was diagnosed based on the detection of a serum cyanide level of 3.5 mg/L. The presence of a high anion gap associated with severe lactic acidosis is a clue for making a rapid differential diagnosis of acute cyanide intoxication. Providing intensive and immediate supportive management is also crucial, even in cases without obtainable specific antidotes.<p /> <p>Language: en</p>",
language="en",
issn="0918-2918",
doi="10.2169/internalmedicine.54.4272",
url="http://dx.doi.org/10.2169/internalmedicine.54.4272"
}