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Sodium-nitroprusside Lactic acidosis and altered mental status secondary to sodium-nitroprusside toxicity: case report

A 41-year-old man developed lactic acidosis and altered mental status secondary to sodium nitroprusside toxicity during treatment of cardiogenic shock. The obese man presented with a chief complaint of the lower extremity oedema and progressive dyspnoea on exertion for 2 months. He started receiving sodium nitroprusside infusion at 26 µg/min and transferred to the cardiac ICU for the management of cardiogenic shock. Over the next 16 hours, his condition improved on sodium nitroprusside infusion after reaching a rate of 0.4 µg/kg/min (total dose 52 µg/min). Within the next 6 hours, he developed new altered mental status, becoming only oriented to self, inappropriately answering questions and eventually becoming lethargic with difficulty in keeping his eyes open. At that time, his laboratory tests were notable for a new lactic acidosis with a lactate level of 7.5 [unit not stated]. A cyanide level was noted to be elevated. The man was treated with thiosulfate in view of cyanide toxicity. Consequently, he showed a complete resolution of lethargy and altered mental status. He became alert and oriented to place, time and person. Laboratory findings showed resolution of the lactic acidosis. Karim A, et al. Cyanide toxicity at "safe" dose of sodium nitroprusside within 24 hours of treatment. American Journal of Respiratory and Critical Care Medicine 199: (plus 803446584 poster) abstr. A4804, No. 9, May 2019. Available from: URL: http://doi.org/10.1164/ajrccm-conference.2019.199.1_MeetingAbstracts.A4804 [abstract]

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Reactions 18 Jan 2020 No. 1787