Prevalence of hydrogen cyanide and carboxyhaemoglobin in victims of smoke inhalation during enclosed-space fires: a combined toxicological risk

Abstract

Medical procedures in persons rescued from enclosed-space fires, especially in the pre-hospital setting, should be augmented to cover the possibility of toxic HCN exposure, particularly in individuals who do not respond to standard supportive therapy. Likewise, post-mortem investigations should routinely include assays for HCN when determining probable cause of death.

Assessment of carboxyhemoglobin, hydrogen cyanide and methemoglobin in fire victims: a novel approach

“…Several published papers report the generation of hydrogen cyanide (HCN) during the combustion of polymers containing nitrogen in their molecular structure [9][10][11][12][13], such as the polyurethane used in the manufacture of mattresses or acoustic soundproofing in night clubs and music venues.…”

Tongue protrusion as an indicator of vital burning

“…in a 1969 publication questioned the reliability of increased COHb as being definitive of vital burning [7]. The importance of COHb has recently been highlighted by several authors, and is considered an important indicator of vital burning [8][9].…”

Case Files of the University of Massachusetts Toxicology Fellowship: Does This Smoke Inhalation Victim Require Treatment with Cyanide Antidote?

“…The presence of carboxyhemoglobinemia greater than 10 % is evidence of significant smoke inhalation, placing the patient at higher risk for having inhaled other toxins, including cyanide. Carbon monoxide levels and cyanide levels are correlated according to several case series of patients with smoke inhalation, and a retrospective analysis of 285 fire-related fatalities [3,13,24,27,39]. Both toxins are cellular asphyxiants, and several authors proposed that carbon monoxide toxicity is synergistic to that of cyanide; death may result despite sublethal levels of either toxin [8,9,12].…”

“…Experts suspect that the amount of hydrogen cyanide in fire-related smoke has increased over the past decades due to use of novel, synthetic building and furnishing materials [4]. Cyanide is detectable in the blood of almost 60 % of fire-related fatalities and 50 % of survivors of enclosed-space fires [3].…”

“…On average, there are 2580 deaths and 13, 280 injuries per year associated with fires in the USA [1], most of them due to the inhalation of smoke [2]. While the composition of smoke is highly variable and depends on fuel available for pyrolysis, temperature, and oxygen availability [3], two common inhalational toxicants found in smoke are carbon monoxide and hydrogen cyanide. Both gases are cellular asphyxiants, respectively competing for oxygen binding sites on hemoglobin or inhibiting cytochrome c oxidase in mitochondrial oxidative phosphorylation.…”