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Cyanide Toxicology - Causes, Symptoms, Diagnosis, Treatment, and Prevention

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Cyanide toxicity is the nitroprusside infusion causing symptoms like nausea, restlessness, vomiting, and sweating, which subsides when the injection is reduced.

Written by

Dr. Osheen Kour

Medically reviewed by

Neha Suryawanshi

Published At November 9, 2022
Reviewed AtFebruary 24, 2023

Introduction

Cyanide is a dangerous poison causing many homicidal and suicidal deaths. It is primarily found in the form of Hydrogen Cyanide (HCN), which is colorless at room temperature. People usually get exposed to cyanide through exhaust from vehicles or mills and industrial treatment work, contaminating water due to the discharge of wastes from chemicals or iron steel industries. In addition, any substance that has nitrogen and carbon content present can release cyanide under a particular condition when burnt.

What Is Cyanide?

Cyanide is a harmful, deadly substance in various forms, such as Hydrogen cyanide (HCN) in colorless gaseous form and Potassium cyanide (KCN) in crystal form.

What Are the Causes of Cyanide Toxicity?

Cyanide poisoning is usually caused by medical exposures, industrial fireworks, and domestic fires. Electroplating injury, fumigation, metallurgy pesticides, rubber manufacturing, etc., are some examples of cyanide used for manufacturing. Also, some hypertensive medical emergency cases are treated with the help of cyanide exposure, thus, causing poisoning in the body over time. Cyanide poisoning can be caused by infusion, inhalation, or ingestion exposure leading to death in patients by cardiac arrest, respiratory failure, or metabolic acidosis.

What Are the Types of Cyanide Toxicity?

  • Acute Cyanide Poisoning - This usually occurs due to unintentional exposure to cyanide and requires immediate treatment before it becomes life-threatening. Symptoms associated with acute poisoning include seizures, cardiac arrest, difficulty breathing, and loss of consciousness.

  • Chronic Cyanide Poisoning - Prolonged exposure to hydrogen cyanide gas over 20 to 40 ppm can lead to severe poisoning. It causes dilated pupils, vertigo, drowsiness, convulsions, nausea, and vomiting.

What Are the Different Sources of Cyanide Toxicity?

  • Plants - Some plants contain cyanogenic properties and can cause cyanide poisoning. These include apricot, plum, pear, peach, apple, etc. In addition, some varieties of potatoes called cassava can also cause toxicity. However, only high levels of ingestion of these plants can cause cyanide toxicity.

  • Fire - Burning of rubber or plastic substances releases smoke, causing toxicity.

  • Photography, fumigation, chemical processing, and industrial electroplating use hydrogen cyanide, and insecticide manufacturing use potassium cyanides, which causes severe environmental toxicity.

  • Smoking - Tobacco is also one of the significant sources of cyanide, found naturally; therefore, cigarette smoking can cause severe cyanide poisoning in people.

  • Some varieties of chemicals like nail paint removers and other thinners are no longer available in the market as they can automatically develop cyanide poisoning in the body.

What Are the Signs and Symptoms of Cyanide Toxicity?

  • Breathing difficulties.

  • Nausea.

  • Vomiting.

  • Body weakness.

  • Headache.

  • Mental confusion.

  • Unconsciousness.

  • Cardiac arrest.

  • Abdominal pain.

  • Seizures.

  • Prolonged sleep.

What Are the Chronic Effects of Cyanide Toxicity?

  • Central Nervous System - Studies show the consumption of cassava ( a potato variant) can cause chronic degenerative neuropathy and other neurological effects.

  • Cardiovascular and Respiratory Effects - Cyanide usually affects the respiratory and cardiovascular systems, secondary to the central nervous system. It can cause hypoventilation, myocardial infarction, and reduced cardiac output.

  • Endocrine Effects - Some studies have shown thyroid gland enlargement due to cyanide poisoning. In contrast, in some studies, goiter and cretinism are prevalent due to cassava consumption which has a cyanogenic effect on the body.

  • Developmental Effects - Low birth rate cases have been found in women with high levels of cyanide exposure.

What Is the Pathophysiology of Cyanide Toxicity?

Cyanide symptoms are usually produced more rapidly during intravenous and inhalation than an oral route into the body because cyanide diffuses faster into the bloodstream through these routes only. This blood toxicity due to cyanide poisoning is mainly caused by aerobic cell metabolism stoppage. Inside the mitochondria, cyanide binds with a ferric ion compound, which blocks oxygen reduction to water and inhibits cellular respiration. Cyanide inhibits oxidative phosphorylation and produces ATP ( Adenosine triphosphate) as cellular energy by utilizing oxygen. This leads to metabolic acidosis by cellular hypoxia and ATP depletion. This causes harmful effects to the vital organs as the tissues in the body use oxygen, and this causes cyanide toxicity in the body.

How to Diagnose Cyanide Toxicity?

  • Caboxyhaemoglobin Level - This helps diagnose the amount of smoke inhaled due to cyanide exposure.

  • Methemoglobin Level - It is used to diagnose injury due to smoke inhalation.

  • Blood or Plasma Lactate Level - This usually does not help diagnose cyanide poisoning initially but can later confirm the poisoning due to prolonged exposure.

What Are the Treatment Options for Cyanide Toxicity?

  • Cyanokit (Cyanide Antidote Kit)- It is used in cases of cyanide exposure suspected in the patient. Although this treatment does not provide a proper cure to the condition, it can only prevent any further spread of poison in the patient's body.

  • Dicobalt Edetate - It is another treatment method used to eliminate cyanide from the body after exposure by intravenous route. It has side effects like low blood pressure, anaphylaxis, and seizures. Case assistance from a local toxicologist or specialist can help deal with the case.

  • In case of low exposure, a patient can be sent home after a few hours, but if the exposure level and poisoning effect are too high, the patient must be admitted to the hospital for proper treatment.

How to Prevent Cyanide Toxicity?

  • Proper care against domestic or residential fire must be ensured. If possible, smoke detectors should be installed, and halogen lamps and cigarette smoke must be avoided inside the house.

  • Chemicals containing toxic substances must be kept in air-tight containers under lock and key to avoid exposure to children.

  • Occupational hazards can be avoided by using absorbent papers or protecting work surfaces. Ensure to keep chemicals in labs or factories; workplace uniforms or dresses must not be bought at home as they can also cause exposure to other people.

  • Dispose of your clothes, hand gloves, and mask completely in zipped plastic bags after using them to prevent the spread of toxins.

Conclusion

Cyanide can be rapidly absorbed by the body through various routes and therefore requires immediate treatment and medical assistance as its effects can be fatal, leading to death. Though the prognosis of the person affected with cyanide toxicity is challenging, continuous observation and monitoring of symptoms and progress in condition before and after admission to the hospital can be reliable predictors in cyanide poisoning incidents.

Neha Suryawanshi
Neha Suryawanshi

Nutritionist

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