A 64-year-old man with acute aortic dissection presents with severe hypertension (BP 210/120 mmHg, HR 110/min, RR 22/min). He receives intravenous nitroprusside for blood pressure control. Several hours later, he becomes confused and agitated. Laboratory studies reveal severe lactic acidosis (pH 7.18, lactate 12 mmol/L) and elevated cyanide levels. He has no prior renal disease or cyanide exposure. Which of the following toxicities best explains this clinical deterioration?
- A)Salicylate poisoning
- B)Acetaminophen induced hepatic necrosis
- C)Cyanide accumulationGABARITO
- D)Methemoglobinemia from dapsone
- E)Lead chelation failure
Explicação
Nitroprusside releases nitric oxide but can also generate cyanide, especially with prolonged high dose use. Cyanide poisoning impairs oxidative phosphorylation, leading to lactic acidosis and altered mental status. Ver explicação completa e trilha adaptativa →