Question - How frequently are “cherry red skin” and the “odor of almonds” actually identified in patients suffering from cyanide toxicity?
Answer - The authors of a recent systematic review concluded “Contrary to general reviews published on cyanide toxicity, reports of cherry red skin and bitter almond odor were rare among published cyanide cases. Consistent with other studies, metabolic acidosis with significant lactic acidosis were the laboratory values consistently associated with cyanide toxicity. Health care providers may overlook cyanide toxicity in the differential diagnosis, if certain expected characteristics, such as the odor of almonds or a cherry red color of the skin are absent on physical examination.” (Parker-Cote JL, et al. Challenges in the diagnosis of acute cyanide poisoning. 2018 Clin Tox 56(7):609-617)