رجل عمره ٥٩ سنة في العناية على تسريب نيتروبروسيد منذ ٣ أيام لطارئ ضغط مع تسلخ أبهري، وعنده ضعف في وظيفة الكلى. صار عنده تشوش وطنين في الأذن وتشنجات عضلية، والتحليل يظهر حماضاً استقلابياً واللاكتات مرتفع. ما المضاعفة التي يشك بها الممرض؟

A 59-year-old man in ICU has been on a nitroprusside infusion for 3 days for a hypertensive emergency with aortic dissection and has impaired renal function. He develops confusion, tinnitus and muscle twitching; labs show metabolic acidosis with high lactate. Which complication does the nurse suspect?

1. An allergic reaction to the drug
2. Cyanide or thiocyanate toxicity
3. Hypoglycaemia from fasting
4. Intracranial haemorrhage from BP lowering

Answer: B) Cyanide or thiocyanate toxicity. Nitroprusside breaks down to cyanide then thiocyanate, which can accumulate with prolonged or high doses or renal impairment, causing confusion, lactic acidosis and tinnitus. The prescriber is told at once so it can be stopped and treated.