Yadukul et al.

, J Forensic Toxicol Pharmacol 2014, 3:3

http://dx.doi.org/10.4172/2325-9841.1000123

Journal of Forensic
Toxicology & Pharmacology

Case Report

a SciTechnol journal
The fatal dose of hydrocyanic acid can be given as follows:

Fatal Suicidal Case of Cyanide

Poisoning- A Case Report

HCN gas: 100-200ppm in air.

HCN liquid: 50-60mg.

Yadukul S *, Venkataraghava S , Fathima T and Gaonkar VB

1

Abstract
Hydrocyanic acid (HCN) is a solution of HCN in water (either 2%
or 4%), the 4% solution being called sheeles acid. Cyanides
are white powders and are in common use in many trades like
metallurgy, photography, electroplating, fumigation of ships and
aircrafts and in agriculture for spraying to destroy blight. Here we
present a case of fatal cyanide poisoning wherein the person had
taken the compound orally, developed convulsions and declared
brought dead in the nearby hospital.

KCN, NaCN: 150-300mg

The fatal dose of cyanides being small, prominent Nazis allowed
it to be used as hidden suicide pills/capsules at the end of the last war
[3].
Onset of action depends on the form of the poison, concentration
and rate of absorption. When the gas is inhaled, consciousness may
be lost at once and prompt death may occur due to respiratory arrest.
After ingestion, symptoms appear within minutes, during which
time, the victim may perform certain voluntary acts, such as corking,
or throwing away the bottle or walking a little distance [1-3].

Keywords

Case Details

Hydrocyanic acid; Cyanide poisoning; Sheeles acid

History

Introduction
Hydrocyanic acid is a very potent, extremely lethal and rapidly
acting substance. Poisoning with HCN is almost always fatal because
of the low fatal dose and the rapidity with which it acts. HCN is toxic
to all living beings except bacteria [1]. The pure acid is a colorless,
transparent, volatile liquid with an odor resembling that of bitter
almonds. It decomposes rapidly on exposure to light. About 20 - 40%
of the population cannot smell the gas, and the ability to detect it is a
sex-linked recessive trait. Potassium ferro-cyanide and ferri-cyanide
are not poisonous [2]. Hydrocyanic acid forms cyanides with metals.
Of these, potassium and sodium cyanide, mercuric cyanide and silver
cyanide are used in photography, electroplating, hardening of steel,
silver processing, gold processing and dyeing. These salts are soluble
in water, alkaline in reaction and highly poisonous. Calcium cyanide
is cheaper and is used in mining industry. Magnesium cyanide and
cyanogen chloride are used as insecticides [3]. Cyanides are produced
in major fires where the burning of wool, silk, nylon, polyurethane,
polyacrylonitrile releases hydrogen cyanide [3].

Mechanism of action
Cyanide inhibits the action of cytochrome oxidase, carbonic
anhydrase and probably of other enzyme systems. It blocks the final
step of oxidative phosphorylation and prevents the formation of ATP
and its use as energy source. Cyanides acts by reducing the oxygen
carrying capacity of the blood, and by combining with the ferric iron
atom of intracellular cytochrome oxidase, preventing the uptake
of oxygen for cellular respiration. There is an interference with the
intracellular oxidative processes in the tissues and it kills by creating
histotoxic anoxia, although the blood may contain normal oxygen
content [2].
*Corresponding author: Dr. Yadukul S, Assistant Professor, Department of
Forensic Medicine and Toxicology, Sapthagiri Institute of Medical Sciences and
Research Centre, Bengaluru, India, Tel: +91(0)9986510681; E-mail: dr.koooool@
gmail.com
Received: March 20, 2014 Accepted: June 20, 2014 Published: June 27, 2014

International Publisher of Science,

Technology and Medicine

As per the inquest by Magadi Road Police station, a case was

booked under 174CrPC (Criminal Penal Code in Indian law) on
19/05/2012 for alleged history of consumption of an unknown
compound. The deceased was a 19yr old male, who developed
generalized convulsions on 19/05/2012 at 12:30p.m, and was taken to
a nearby hospital, where he was declared brought dead. The autopsy
was done at the Department of Forensic Medicine and Toxicology,
Victoria Hospital, Bangalore Medical College and Research Institute,
Bengaluru, India on 20/5/2012.

Autopsy findings
The dead body was that of a male (Figure 1) measuring 166cm in
length, moderately built and nourished. Rigor mortis was appreciated
all over the body. Bright red post-mortem staining was present over
the back of the body. There were no demonstrable external injuries
present over the body. Lungs Congested and edematous; cut section
exudes blood mixed with froth. Stomach - Contains 100ml of brown
color fluid; smells peculiar; mucosa congested (Figure 2). Brain
was softened and edematous. All the other organs were intact and
congested. Blood and viscera was collected and sent to the Forensic
Science Laboratory for chemical analysis. Whole brain was preserved
& sent for Histo-pathological examination.

Forensic science laboratory report

Color tests have demonstrated the presence of cyanide ions in the
blood & viscera sent.

Histo-pathological examination report

Gross Unremarkable; Microscopic Examination partial
autolytic changes in all the viscera sent; appears to be within normal
limits.

Cause of death
On perusal of Forensic Science Laboratory opinion, Histopathological Examination report & Autopsy findings, I am of
the opinion that Death is due to Respiratory Failure as a result of

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Citation: Yadukul S, Venkataraghava S, Fathima T, Gaonkar VB (2014) Fatal Suicidal Case of Cyanide Poisoning- A Case Report. J Forensic Toxicol Pharmacol
3:3.

doi:http://dx.doi.org/10.4172/2325-9841.1000123
have been described in the gastro esophageal mucosa with cyanide
ingestion [3]. If the death occurs rapidly, one is unlikely to detect
inflammation since it takes time to develop. Not every case of cyanide
ingestion shows hemorrhagic gastric mucosa. This may be a reflection
of the amount of cyanide ingested or the amount of food present in
the stomach at the time of ingestion [3].

Conclusion
Although Hydrocyanic acid and its salts were used as suicidal
agents in earlier years, their use in the present era has declined
drastically. The present case is reported here because of the rarity of
cyanide poisoning in the recent years.
References
1. Nandy A (2010) Principles of Forensic Medicine Including Toxicology (3rd
edn). New Central Book Agency (P) Ltd, Kolkata, India.
Figure 1: Deceased who consumed cyanide.

2. Reddy KSN (2013) The Essentials of Forensic Medicine and Toxicology (32nd
edn). Om Sai Graphics, Hyderabad, India.
3. Vij K (2012) Textbook of Forensic Medicine and Toxicology; Principles and
Practice (5th edn). Elsevier Health Scienecs, India.
4. Fernando GC, Busuttil A (1991) Cyanide ingestion. Case studies of four
suicides. Am J Forensic Med Pathol 12: 241-246.
5. Ballantyne B (1970) Autopsy findings following death by intramuscular
hydrogen cyanide: an experimental study. Med Sci Law 10: 171-174.
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studies of four suicides and one homicide. Am J Forensic Med Pathol 23:
315-320.
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4: 161-165.
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high levels of cyanide in blood. J Forensic Sci Soc 27: 253-259.

Figure 2: Stomach mucosa congested.

consumption of a substance containing cyanide.

Discussion
There are no reliable autopsy findings that are diagnostic
of cyanide intoxication. The classical description of the autopsy
findings in case of cyanide ingestion include: pink lividity, an odor
of bitter almonds, gastritis, and oral/ peri-oral erosions. The bright
pink lividity has been differentiated from the cherry pink lividity
of carbon monoxide poisoning. The pink or lilac lividity is not
pathognomonic of cyanide poisoning and is not always seen in
cyanide deaths. As other studies have also demonstrated, the pink
lividity of cyanide poisoning is neither specific nor sensitive for
cyanide intoxications [4-6]. Guyana has had its share of tragedies with
cyanide. The mass Jonestown suicide-homicides in 1978 involved
the deaths of over 900 people [7]. The postmortem interpretation
of cyanide concentrations has its own pitfalls due to reports of both
postmortem degradation and production of cyanide [8-14].
Cyanide is a corrosive substance. It gradually deteriorates tissues
that it comes in contact with. When ingested, the stomach may
show signs of corrosion by the hemorrhagic appearance of mucosa.
Corrosives do not need to elicit inflammation (as irritants do), to
cause damage. Various microscopic epithelial morphological changes
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10. Chikasue F, Yashiki M, Kojima T, Miyazaki T, Okamoto I, et al. (1988) Cyanide

distribution in five fatal cyanide poisonings and the effect of storage conditions
on cyanide concentration in tissue. Forensic Sci Int 38: 173-183.
11. Padwell A (1997) Cyanide poisoning. Case studies of one homicide and two
suicides. Am J Forensic Med Pathol 18: 185-188.
12. Baud FJ, Borron SW, Bavoux E, Astier A, Hoffman JR (1996) Relation
between plasma lactate and blood cyanide concentrations in acute cyanide
poisoning. BMJ 312: 26-27.
13. Gill JR, Goldfeder LB, Stajic M (2003) The happy land homicides: 87 deaths
due to smoke inhalation. J Forensic Sci 48: 161-163.
14. Noguchi TT, Eng JJ, Klatt EC (1988) Significance of cyanide in medicolegal
investigations involving fires. Am J Forensic Med Pathol 9: 304-309.

Author Affiliations

Top

Assistant Professor, Department of Forensic Medicine and Toxicology,

Sapthagiri Institute of Medical Sciences and Research Centre, Bengaluru, India
2
Associate Professor, Department of Forensic Medicine and Toxicology,
Bangalore Medical College and Research Institute, Bengaluru, India
3
Medical student, Bangalore Medical College and Research Institute,
Bengaluru, India
1

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