Other – Ingestion of cyanide salts, such as potassium cyanide and sodium cyanide, continues to be a method of both suicide and homicidal/terrorist acts.Other foods containing possible cyanogens include cassava root, bamboo shoots, and soy. The common (ie, sweet) almond does not cause cyanide intoxication. These foods all contain cyanogenic glycosides, such as amygdalin, in their pits and seeds. Diet – The family Rosaceae, which includes the bitter almond, cherry laurel, apricot, plum, peach, pear, and apple, is responsible for many reported cyanide poisonings.(See "Drugs used for the treatment of hypertensive emergencies", section on 'Nitroprusside'.) ![]() Methods for preventing nitroprusside-induced cyanide poisoning include using silver foil on IV tubing (preventing light from decomposing the nitroprusside molecule), using maximal infusion rates of 2 mcg/kg per minute, and adding sodium thiosulfate to the nitroprusside solution. ![]() Treatment for 3 to 10 hours with 5 to 10 mcg/kg per minute has resulted in fatalities. Toxic levels of cyanide may be reached in patients who receive prolonged infusions of sodium nitroprusside, in patients with chronic renal failure, or in pediatric patients. Sodium nitroprusside, a medication used in the treatment of hypertensive emergencies, contains five cyanide groups per molecule. This enzymatic reaction explains why only gastrointestinal exposure, in contrast to intravenous (IV) administration, results in toxicity. Intestinal beta-d-glucosidase digests the amygdalin, releasing hydrogen cyanide (HCN). Laetrile is available as a 500 mg oral tablet that contains 30 to 150 mg of amygdalin. The drug is alleged to kill cancer cells selectively via its metabolite, hydrocyanic acid. Amygdalin (trade name Laetrile), a substance derived from apricot and peach kernels and introduced as an antineoplastic agent in the 1950s, can cause severe cyanide toxicity. Medical – Cyanide exposures can result from alternative and standard medical treatments.Splashes of cyanide solutions can result in dermal as well as mucosal absorption. The combination of cyanide salts and acid, as utilized in electroplating, results in the release of cyanide gas, which can lead to lethal inhalational exposures. ![]() Skin contact with cyanide salts can result in burns, which allow for enhanced absorption of cyanide through the skin. Metal extraction in mining, electroplating in jewelry production, photography, plastics and rubber manufacturing, hair removal from hides, and rodent pesticide and fumigants have all been implicated in cyanide poisonings. Industrial – Worldwide industrial consumption of cyanide is estimated to be 1.5 million tons per year, and occupational exposures account for a significant number of cyanide poisonings.Overall, it is reported that significant levels of cyanide are present in up to 35 percent of all fire victims. Toxicologic evaluation of passengers following the 1985 explosion of a Boeing 737 during takeoff in Manchester, England, revealed that 20 percent of the 137 victims who escaped had dangerously elevated levels of carbon monoxide, while 90 percent had dangerously elevated levels of cyanide. Vehicular fires can also expose victims to cyanide. These products include wool, silk, polyurethane (insulation/upholstery), polyacrylonitriles (plastics), melamine resins (household goods), and synthetic rubber. Cyanide can be liberated during the combustion of products containing both carbon and nitrogen. Fire-related – In industrialized countries, the most common cause of cyanide poisoning is domestic fires.Cyanide poisoning may result from a broad range of exposures ( table 2). Also, approximately 150 to 200 administrations of cyanide antidotes (eg, hydroxocobalamin, sodium thiosulfate) are reported annually to United States regional poison control centers. (See "Approach to the child with occult toxic exposure".)ĮPIDEMIOLOGY AND SOURCES OF EXPOSURE - Approximately 150 to 200 single-substance non-rodenticide cyanide exposures involving two to four fatalities are reported annually to United States regional poison control centers.(See "Initial management of the critically ill adult with an unknown overdose".).(See "General approach to drug poisoning in adults".).A general approach to the poisoned patient is found separately. This topic review will discuss the toxicity and management of cyanide poisoning. A summary table to facilitate emergency management is provided ( table 1). ![]() Though significant cyanide poisoning is uncommon, it must be recognized rapidly to ensure prompt administration of a lifesaving antidote and supportive treatment. Used in both ancient and modern times as a method of execution, cyanide causes death within minutes to hours of exposure. INTRODUCTION - Cyanide is a mitochondrial toxin that is among the most rapidly lethal poisons known.
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