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Health Security. Skip Navigation. Publications Our publications keep professionals working across the public, private, and academic sectors informed on the most important developments and issues in health security and biosecurity. Find an article or report by keywords: Enter Search Phrase. Find an article or report or see all by area, author, or year:. Year Background Cyanide is a naturally occurring chemical, found in many plants, that has been used in conventional warfare and poisoning for 2 millennia.
In , the Japanese cult Aum Shinrikyo placed cyanide in subway bathrooms. Mechanism of Action and Toxicokinetics Cyanide poisons the mitochondrial electron transport chain within cells and renders the body unable to derive energy adenosine triphosphate-ATP from oxygen.
Signs and Symptoms Cyanide kills quickly: death occurs within seconds of a lethal dose of cyanide gas and within minutes of ingestion of a lethal dose of cyanide salt. Signs and symptoms of cyanide poisoning include the following: CNS : headache, anxiety, agitation, confusion, lethargy, seizures, and coma; Cardiovascular : decreased inotropy, bradycardia followed by reflex tachycardia, hypotension, and pulmonary edema; and Other : acute lung injury, nausea and vomiting, cherry-red skin color.
Countermeasures Before cyanide antidote can be administered, the patient must be removed from the cyanide-laden area, clothing removed, and skin washed with soap and water.
Cyanide Antidote Kit : This 3-component process comprising amyl nitrite, sodium nitrate, and sodium thiosulfate releases cyanide from cytochrome a3 by providing a target for which cyanide has a higher attraction. Amyl nitrite, contained in pearls that must be broken and inhaled, and IV sodium nitrate cause the formation of methemoglobin, for which cyanide has a high binding affinity.
This approach uses several basic assumptions which are not strictly correct. These assumptions are that:. Cyanides toxicity shows in relatively very short time. Inorganic cyanides, the most available ones, are very toxic when ingested but their solution in water is even more toxic. Potassium, sodium and many of the other inorganic cyanides are water soluble. Therefore, when ingested, they quickly form solutions in the stomach which rapidly enters the blood and circulate through every part of the body.
The toxicity is somewhat reduced if alcohol and sugar are present simultaneously with the cyanide. The reason is that the cyanide ion can react with the sugars to form amygdalin. This compound is not very stable and decomposes in water to reform cyanides and sugar. The exact confirmed evidences are sketchy, but one possibility is that the effective amount of cyanide ingested was reduced due to its reaction with the sugars in the wine to form the less toxic amygdalin.
A few cases were documented where people died after breathing HCN vapors released where attempts were madeto clean cyanide-containing vessels with acids. A laboratory cleaning lady died a few years ago breathing HCN vapors released from a sink after pouring into it a cleaning acid.
Previous worker poured in it cyanide. The action of cyanides and hydrocyanic acid on living animals, in particular on mammals, is attributed by and large to their irreversible reaction with the iron ions in the blood. This effects the assimilation and transportation of oxygen in the blood to the various parts of the body, which has dire effect on the functioning.
Other mechanisms were proposed and are believed to play a strong role in cyanide toxicity, however, the rapid toxicity is believed to be due to the cyanides interrupting the absorption and assimilation of oxygen.
Since the availability of oxygen is so critical to adequate functioning of the brain and muscles, death due to cyanide poisoning occurs in a relatively short time.
Other metallic ions also react with cyanide ions. Although the toxicity of cyanides is compared with that of other poisons using the LD 50 , in effect, the toxic effect is much more rapid than three days. Moreover, if the victim was reasonably healthy and did not die within a reactively short time, there is a reasonable chance that he will recover.
Several antidotes have been used to overcome the effect of cyanide, but their efficacy is limited. Moreover, it is frequently too late to administer the antidote by the time it is realized that the person was poisoned with cyanide. Cyanide poisoning may be recognized by a smell similar to that of almonds emanating from the victim, his vomit or feces. This smell is somewhat similar to that of Amaretto. The blood of victims of cyanide poisoning appears somewhat bluish, due to the formation of iron complexes with the cyanides.
Prussian Blue. Cyanides are readily available from many different sources. Cyanides are used in many industries and thus are available to potential poisoners.
The main industries that use cyanides are:. The commerce of use of cyanides in most countries is tightly controlled and exporting and importing large quantities of cyanides is a very regulated commerce. He said he had sourced the potassium cyanide from a jewellery shop in Zaveri Bazar for Rs Within seconds of the first sip of water that had cyanide pills added to it, he felt a burning sensation in the throat and recalled spitting out the second sip.
The friend took him to a private nursing home, where the doctor induced vomiting and said he would require critical care. His family moved him to Sion hospital, where doctors from the medicine department put him on a ventilator. After a night-long search, the doctors and the family realised that the city did not have a single unit of the cyanide antidote kit that comprises amyl nitrite, sodium nitrite, and sodium thiosulfate.
An online search revealed that a Hyderabad chemist had it. The kit cost around Rs 28, The key here was to keep him oxygenated, ventilated and hydrated till the antidote came. We gave medicines to support his blood pressure and heart functions.
We could give him hydroxocobalamin, a form of vitamin B12, and that helped too.
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