Cyanide Poisoning: Sources, Effects, and Treatment
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This document discusses cyanide poisoning. It begins by defining cyanide and listing common sources such as fumigation of ships, electroplating, and the plastic industry. Cyanide poisoning can occur through homicide, suicide, or accidents involving these industries. It is absorbed through inhalation, ingestion, or skin absorption. Clinically, it causes rapid death by inhibiting cellular respiration. Signs include a bitter almond smell, nausea, vomiting, and loss of consciousness. Post-mortem, the body has a bright red color and bitter almond odor. Treatment focuses on giving oxygen, activated charcoal if ingested, and dicobalt edetate as an antidote to prevent death.
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Cyanide Poisoning: Sources, Effects, and Treatment
- 2. Contents • What is cyanide • Sources of cyanide • Circumstances of poisoning • Routes of poisoning • Clinical features • Postmortem changes • Management JMJ 2
- 3. What is cyanide? • Highly lethal systemic poison causing rapid death • Derivatives of cyanide Cyanide Gas form Hydrogen cyanide Solid form Potassium cyanide Sodium cyanide JMJ 3
- 4. Fumigation of ships Electroplanting and gold planting Photography and engraving Plastic industry & synthetic rubber industry JMJ 4
- 5. 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 JMJ 5
- 6. 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 JMJ 6
- 7. What does cyanide do in the body? • Reversibly inhibits • Cytochrome oxidase a3 • in mitochondria • Halts cellular respiration • Result in histotoxic anoxia JMJ 7
- 8. 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 JMJ 8
- 10. 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 JMJ 10
- 11. 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 JMJ 11
- 12. 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 JMJ 12
- 13. 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 JMJ 13
- 15. Management • Medical emergency • Always do ABC • If inhaled • Give 100% oxygen • Establish a clear airway • Give antidote JMJ 15
- 16. 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 JMJ 16
- 17. 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 JMJ 17
- 18. JMJ 18
- 19. JMJ 19