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Cyanide Poisoning

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Contents

• What is cyanide• Sources of cyanide• Circumstances of poisoning• Routes of poisoning • Clinical features• Postmortem changes• Management

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What is cyanide?

• Highly lethal systemic poison causing rapid death

• Derivatives of cyanideCyanide

Gas form

Hydrogen cyanide

Solid form

Potassium cyanide

Sodium cyanide

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Sour

ces

of

poison

ing

Cyan

ide

salts

Cy

anid

e ga

s or

hydr

ogen

cyan

ide

Cyan

ide

caps

ule

s

As a

pl

ant

poison

Indu

strie

s

man

ufac

turin

g cy

anid

e

Lab

uses

in

expe

rimen

ts

Fumigation of ships

Electroplanting and gold planting

Photography and engraving

Plastic industry & synthetic

rubber industry

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Circumstances of poisoning

Homicide Suicide Accidental

Those engaged in - Electroplanting- Gold planting- Rubber industry- Lab workers

Cyanide capsules used by

terrorists

War gas used during World War 1

Introduce in to food

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Routes of poisoning

• Inhalation of cyanide gas

• Ingestion • Usually KCN• Combines with gastric acid to liberate

hydrogen cyanide gas

• Skin absorption • Where there is an injury• Where skin is moist with sweat

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What does cyanide do in the body?• Reversibly inhibits

• Cytochrome oxidase a3

• in mitochondria

• Halts cellular respiration

• Result in histotoxic anoxia

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Clinical features

Small doses

• Saltish taste in the mouth • Smell of bitter almonds in

mouth and breath• Signs of GI irritation

• Salivation• Nausea, vomiting

• Difficulty in breathing• Cyanosis

• Vertigo, headache & paralysis• Confusion, drowsiness and

coma

Large doses

• Rapid loss of consciousness, twitching, convulsions, coma death

• Very often they found dead at the scene

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Post Mortem Changes

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Post mortem changes 1/4

• Odour of bitter armonds • On entering the autopsy room• While carrying out general examination• Opening into body cavities

• Bright red or brick red colour of the • Skin• Hypostatic areas• Blood• Muscles • Vascular organs

Due to the presence of excessive

amounts of oxy-hemoglobin

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Post mortem changes 2/4

• At times stomach contents may smell of ammonia

When cyanide salt is old

Alkaline cyanide absorbs water

This solution decompose when contact with air

Form potassium hydroxide , formic

acid, ammonia

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Post mortem changes 3/4

• Diffusely red mucosa of the stomach• At times, mucosa of oesophagus, jejunum also

• Presence of remnants of the “capsule”• Cut injuries to gums, tongue, buccal mucosa

• Presence of plant materials containing cyanogenic glycoside

Should not

confused with

“Velverty red”

appearance in

acute arsenic

poisoning

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Post mortem changes 4/4

• Toxicology

• Following can be sent for analysis• Stomach and contents• Intestinal contents• Blood, urine, vomitus, larvage fluid• Organs such as – liver, kidney, spleen, brain

• Remnants of suspected “food or drinks”

• If the death is due to inhalation of cyanide• Lungs should be sent in a sealed nylon bag

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Management

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Management

• Medical emergency• Always do ABC

• If inhaled • Give 100% oxygen • Establish a clear airway• Give antidote

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Management• If ingested

• Administer activated charcoal• Consider gastric lavage after a large ingestion

• Antidote • Dicobolt edetate

• Antidote of choice• 300 mg IV• Dose can be repeated in severe cases

• Alternative – hydroxocobolamin• Enhances endogenous cyanide detoxification mechanism• 5g IV• Very expensive

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Management

• If not available above 2

• Sodium thiosulphate• 12.5 g IV• Enhancing endogenous detoxification

• Sodium Nitrate• 300 mg IV• It produces methaemoglobinaemia• Methhemoglobin combine with cyanide to form

cyanmethaemoglobin

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