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Cyanide poisoning from smoke inhalation — ABEM Board MCQ

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HardToxicologyCyanide poisoning from smoke inhalationABEM Board

A 36-year-old man arrives as ESI 2 after inhaling smoke in an apartment fire. He has headache, confusion, lactate 9 mmol/L, soot around the mouth, and carboxyhemoglobin 18%. SpO2 reads 99%. Which of the following is the most likely diagnosis?

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Correct answer: B — Cyanide poisoning

Smoke inhalation with severe lactic acidosis and altered mental status suggests cyanide toxicity, often coexisting with carbon monoxide poisoning.

Reference: American Burn Association; Goldfrank Toxicologic Emergencies