For
smoke inhalation injury of a pregnant woman, one must treat two patients and be aware of the potential effects of
carbon monoxide (CO) and
cyanide (CN)
poisoning on both the mother and the fetus. In a pregnant woman, the size and age of the fetus and the degree of
poisoning allow for tremendous variability in the toxicity of CO and CN and their respective treatment options. The authors will review a case of a 32-year-old woman who was at 37 weeks of gestation and admitted to the Evans-Haynes Burn Center after a house fire and received
hydroxocobalamin (Cyanokit) for suspected CN
poisoning. In addition, a review of the literature, current guidelines, and treatment options of inhalation injury during pregnancy will be discussed. The authors will focus only on the toxic components of
smoke inhalation injury rather than the mechanical components from heat and particulate damage. Literature review clearly identifies that the treatment of pregnant women with inhalation injury remains a controversial subject. The use of
hydroxocobalamin (Cyanokit) as a treatment modality for potential CN
poisoning in a pregnant patient has not been reported in the literature. Animal studies have shown that combined CO and CN
poisoning are more lethal than either one alone and at lower concentrations. Due to the synergistic effects of CO and CN, and because these two toxins concentrate at even higher levels in the fetus than the mother, the authors will clarify the urgent seriousness of prompt administration of
hydroxocobalamin in a pregnant patient with suspected
smoke inhalation injury. This case review details the treatment of a 32-year-old woman who was at 36 weeks of gestation on admission to the Evans-Haynes Burn Center. The authors will report her
injuries and the course of treatment. Although burned and presenting with concomitant
smoke inhalation injury, both the woman and her child fared well with no significant complications due to the
smoke inhalation at 6 months of follow-up.
Smoke inhaled from modern structural fires potentially contains both CN and CO
gases. This makes the prompt recognition of this injury and selection of appropriate
therapy an emergent priority. In October 2010, the Food and Drug Administration approved
hydroxocobalamin for use in pregnant patients in the acute setting when CN toxicity is suspected. Because CO and CN have additive effects when both are present in the body, the prompt administration of
hydroxocobalamin not only eliminates the effects of CN but also potentially attenuates its synergistic effects on CO. It is only through a better understanding of the details of
smoke inhalation injury, the current treatment options, and the considerations regarding their use that new research and strong guidelines can be developed to better serve our patients.