There is a significant correlation between blood cyanide concentrations and venous lactate in fire victims. Lactate concentrations above 10 mmol/L are a sensitive indicator of cyanide poisoning in specific conditions. More recently, a group of European experts has proposed emergency management protocols for cyanide toxicity in smoke inhalation victims using serial lactate measurements. While cyanide measurements made it possible to confirm cyanide poisoning retrospectively, repeated determinations of blood lactate levels made it possible to direct antidotal treatment. The correlation between lactate levels and hydroxocobalamin efficacy showed that it was necessary to repeat the administration of the antidote after the starting dose of 5 g of hydroxocobalamin.