CASE 16
A 68-year-old female in a hypertensive crisis is being treated in the intensive
care unit (ICU) with intravenous nitroprusside for 48 hours. The patient’s
blood pressure was brought back down to normal levels; however, she was
complaining of a burning sensation in her throat and mouth followed by nau-
sea and vomiting, diaphoresis, agitation, and dyspnea. The nurse noticed a
sweet almond smell in her breath. An arterial blood gas revealed a significant
metabolic acidosis. A serum test suggests a metabolite of nitroprusside, thio-
cyanate, is at toxic levels.
What is the likely cause of her symptoms?
What is the biochemical mechanism of this problem?
What is the treatment for this condition?
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