Cyanide Poisoning

Cyanide Poisoning – General Information

The Cyanide Poisoning appears when a person or animal ingests cyanide (cyanide is any chemical compound which has the cyano group {C≡N}). The cyanide ion if it is used as poison, it is usually found in the form of gaseous hydrogen cyanide, sodium cyanide or potassium cyanide, which are the most dangerous ones. The Cyanide Poisoning is a common result of the smoke inhalation after fires, but the ingestion is as dangerous as the inhalation, but the ingestion is known to be a deliberate suicidal or criminal act. The cyanide is an inhibitor of the enzyme cytochrome c oxidase (also known as aa3) in the complex of the membrane of the mitochondria of the cells. The cyanide attaches to the iron from this protein, leading to the prevention of the electron transport from the cytochrome c oxidase to oxygen. This leads to the disruption of the electron transport chain, which also leads to the inability of the cells to produce ATP for energy.

The inhalation of cyanide in high concentrations leads to coma, seizures, cardiac arrest and apnea, followed by death in a few minutes. In low concentrations, the inhalation of cyanides leads to loss of consciousness, vertigo, weakness, headache, difficulty in breathing and confusion. In the cases in which a person is exposed regularly to low doses of cyanide the blood cyanide levels increase and this leads to weakness and a large palette of symptoms which also include permanent paralysis.  Here are some of the most common causes of Cyanide Poisoning: smoke inhalation from fires (the cyanide gas can be produced as a chemical reaction), photography industry, as it uses cyanide, chemical research industry, as it uses cyanide, synthetic plastics industry, as it uses cyanide, metal processing industry, as it uses cyanide, electroplating industries.

Cyanide Poisoning – Symptoms

It is well known the fact that any medical disorder (including Cyanide Poisoning) can trigger a variety of symptoms. Therefore, some of this medical condition's most uncommon symptoms have not been listed (mentioned) here. This is why we strongly recommend you to contact your personal health care provider whenever you develop any unusual, bothersome or unpleasant symptoms. Your personal physician will be able to tell you if you are suffering from Cyanide Poisoning or from any other medical disorder. Here is a list of the most common symptoms that a person who suffers from Cyanide Poisoning, may experience, although the signs and symptoms differ depending on how the person is exposed to cyanide (inhalation, swallowing, absorbing, through the skin), on the quantity of the cyanide and on how rapidly it gets in the person’s organism: weakness, confusion, bizarre behavior, coma, excessive sleep, headache, dizziness, shortness of breath, seizures, sudden collapse of the heart, brain problems, the skin becomes pink or cherry-red, rapid breathing or very slow breathing, the breath can smell like bitter almonds, eye irritation, nausea, vomiting, convulsions, hypotension, drowsiness, red face, perspiration, cardiac arrest, restlessness and decreased ability to settle down to watch TV or read, or learn. This medical condition may resemble the symptoms of a heart attack which can include: chest pain, ischemia, angina pectoris, arm, jaw, neck pain, heart burn. Any one can see the fact that the early symptoms, which include: rapid breathing, dizziness, weakness, nausea, vomiting, eye irritation, pink – red skin color, rapid heart rate and perspiration, can masquerade as exhaustion or a cardiac problem. But the secondary symptoms can also pass as a myocardial infarction, when the true diagnostic is the poisoning with cyanide.

Cyanide Poisoning – Treatment

The treatment can vary, depending on how sick the patient really is. In the cases when the person is unconscious, the doctors will try to save her life, and they can use a variety of methods in order to save it. Such methods are:

• Placing a tube down the person’s throat to breath for the victim
• Inserting multiple catheters in the blood vessels and bladder

If the condition of the patient is not life threatening, then the doctors will submit him to an investigation. First of all, the patient must take all his clothes off, because the cyanide can continue to affect the person through skin absorption. The patient’s stomach may be pumped if there is any evidence of cyanide ingestion - doctors introduce a tube through the mouth into the stomach and wash the stomach. A special antidote kit can be used if the Cyanide Poisoning is suspected or exists in order to prevent the cyanide from continuing to poison the person. This antidote kit contains: Amyl nitrite, sodium nitrite and sodium thiosulfate, and also high doses of oxygen. The amyl nitrate should be administered for approximately 30 seconds each minute. The ampule is broken during the pause between two pads of gauze, and it is placed overt the airway. A new ampule should replace the broken one at every 3 minutes. The sodium nitrite is given intravenously from a dose of 5 ml to a total dose of approximately 10 to 15 ml. The sodium thiosulfate is given also intravenously over 1 to 2 minutes at a dose of approximately 50 ml, after the amyl nitrite and sodium nitrite have been administered. The oxygen is administered in high doses. When the patient has carbon monoxide poisoning, too, then he is submitted to hyperbaric oxygen therapy. If the risk of real cyanide ingestion is low, then the patient will be kept under surveillance for a few hours and if it does not happen anything, he is free to go home.

Here is a list of drugs which the doctors or personal health care providers may prescribe to the patient who suffer from Cyanide Poisoning: Hydroxocobalamin injection (this is a form of vitamin B12) - it is used to bind the cyanide to form vitamin B12 cyancobalamin (the cyancobolamin is eliminated through the urine), Cyanokit, Tylenol, Dicobalt edetate –this drug is used only in the severe poisoning cases, 4-dimethylaminophenol (also known as DMAP) – this drug has been proposed in Germany as an antidote to the Cyanide Poisoning, Cobalt slats – are also effective in binding cyanide: Kelocyanor.
Parents and doctors should know the fact that the treatment of Cyanide Poisoning with nitrite thiosulfate is only for adults and it is possibly lethal for children who are under twenty-five kilograms in weight. If there is no other treatment option, the child can be administered nitrite thiosulfate but the dose must be calculated depending on the quantity of hemoglobin the child has, because if the child is given an adult does this can lead to lethal methemohglobinemia. Researchers have discovered the fact that a child who has 12gm/100 ml of hemoglobin can be given a dose of maximum 10mg/kg (immediately when he is diagnosed with Cyanide Poisoning) and after that 5mg/kg after 30 minutes, but only if it is necessary.