Cyanide

Poisoning
 Cyanide
• Poisonous chemical
• Makes difficult for red blood cells to carry O2
• Found as solid or gas
• Smell like almond
• May be accidently exposed or used as weapon
• Cause severe symptoms and life threatening
 Sources
• Fires
• Plants like apricot seeds and cassava
Cyanogenic Grasses:
johson grass
sudan grass
common sorghum
 Sources

• Photography
• Chemical research
• Synthetic plastic
• Metal processing
• Electroplating industries
• Cigarette smoke
 Sources
• Leatrile\amygdalin(cyanogenic glycoside)

Beta-glycosidases hydrolysis

Benzaldehyde + cyanide
Lethal dose
• Potassium or sodium cyanide 200-300mg/kg
• Hydrocyanic acid 50mg/kg for oral
1.1mg/kg for IV
100mg/kg after skin exposure

• Lethal amount of plant materials ingested

4mg HCN/kg
 Toxicokinetics

• Absorption:
absorbed through lungs, GI tract and skin

Distribution:
Distributed throughout body via blood
 Metabolism of cyanide
• Cyanide +thiosulfate thiocyanate

• for this reaction sulfur is provided by

Rhodanese (hepatic mitochondrial thiosulfate sulfer
transferase)
Beta-mercaptopyruvate-cyanide sulfur transferase
• Thiocyanate
Relatively non-toxic
Excreted through urine
Metabolism of cyanide
 MECHANISM OF TOXICITY

 Mainly inhibit cellular respiration

 No oxidative phosphoraylation
 Cells use anaerobic metabolism
 Production of lactic acid
 Metabolic acidosis
In addition
it may also Decrease carbohydrate metabolism
Vasoconstriction decrease blood flow toward heart ,brain
 Mechanism of toxicity
 cyanide radical+ ferric iron , cupric copper of cytochrome oxidase(a3)

changed the integrity and structure of cytochrome oxidase

Inhibition of electron transport system and ATP generation

decrease cellular utilization of oxygen ( hypoxia) 

Mechanism of toxicity
Mechanism of toxicity
Clinical effects of cyanide
• CNS
• Headache
• Dizziness
• Seizures
• Coma

• Cardiovascular
• Bradycardia
• Hypotension
• Cardiovascular collapse
 Clinical effects of cyanide

• Pulmonary
• Dyspnea
• Tachypnea
• Pulmonary edema

• Gastrointestinal
• Nausea,
• vomiting
 Signs and symptoms
• Mild Toxicity
• Nausea
• Dizziness
• Drowsiness
• Moderate Toxicity
• Loss of consciousness for a short period
• Convulsion
• Vomiting
• Cyanosis
 Signs and symptoms
• Severe Toxicity
• Deep coma
• Dilated non-reactive pupils
• Deteriorating cardio-respiratory function
 Lesions
Blood may be bright red
 Turn to dark red on exposure to air
Blood remain unclotted
GIT and lungs congestion
When abdomen /rumen is opened , it is filled up with gas and
odour of “Bitter almonds”
Diagnosis
• History
Occupation, access to cyanide
• Smell
Bitter almonds
• Skin color
Cherry red
• Serum lactate
elevated
 Differential diagnosis
• Carbon monoxide :
Color of blood is bright red but death is not so acute
• Nitrate & Nitrite:
death is rapid but color of blood is brown red
• Urea poisoning :
death is rapid but main signs are colic ,
nervous and behavioral changes
 Treatment
Management
Cyanide is hazardous by:
 Ingestion
 Respiratory exposure
 Dermal exposure
 Treatment
 Gastric lavage
 Activated charcoal
 Antidotes
 Antidotes
Chelating agents :
 Hydroxocobalamin
 Dicobalt edetate
Methaemoglobin forming agents:
 Amyl nitrite
• Sodium nitrite
• Sodium thiosulfate
 Chelating agents

Hydroxocobalamin +cyanide non-toxic cyanocobalmin

Dicobalt edetate + cyanide cobalt cyanide complex

 Methaemoglobin forming agents

Cyanide Antidote Kit

Contents
• Amyl nitrite
• Sodium nitrite
• Sodium thiosulfate,
 Methaemoglobin forming agents
NaNO2 or amylnitrite
hemoglobin methemoglobin

Methemoglobin(ferric iron) + cyanide ─cytochrome oxidase complex

cyanomethemoglobin + cytochrome complex reactivate

Sodium thiosulfate

thiocyanate
(excreted through urine)
References
 VETERINARY TOXICOLOGY Basic and Clinical principles by RAMESH C.GUPTA
 http://www.kumed.com/~/media/Imported/kumed/documents/kdhehydrogensulfide.ash
x?la=en
 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/337722/
Hydrogen_Sulphide_Toxicological_Overview_phe_v1.pdf
 Way JL. Cyanide intoxication and its mechanism of antagonism. Ann Rev Pharmacol
Toxicol 1984; 24: 451-481.
 Chen KK, Rose CL. Nitrite and thiosulfate therapy in cyanide poisoning. JAMA 1952;
149: 113-119.
 Chen KK, Rose CL. Treatment of acute cyanide poisoning. JAMA 1956; 162: 1154-
1155.