cyanide poisoning

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Cyanide poisoning:

Cyanide poisoning BY VICHITRA CYANIDE POISONING BY Dr. Rahul Dandekar

CYANIDE POISONING:

CYANIDE POISONING Cyanide occur as solid , liquid or in gaseous state as : GAS FORM : HYDROGEN CYANIDE (HCN) LIQUID FORM : HYDROCYANIC ACID (PRUSSIC ACID) SOLID FORM :OCCURS AS SALTS SUCH AS POTASSIUM CYANIDE/SODIUM CYANIDE

SOURCE::

SOURCE: PLANTS : Cyanide is present in the form of cyanogenic glycoside in wide variety of plants such as *BITTER ALMOND *SORGHUM *JOHNSON GRASS *BAMBOO *APRICOT *PEACH 2. COMBUSTION : such as * Burning of plastic furniture * Burning of silk or wool * Cigarette smoking

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HYDROCYANIC ACID ( Prussic acid or cyanogen ) is a solution of Hcn in water either 2% or 4% , latter being called “ Scheele’s acid”. Hydrocyanic acid is usually obtained from distilling of cyanide by an acid . The pure acid is a colourless , transparent , volatile liquid with an odour like bitter almonds and is rapidly decomposed by light exposure . HCN normal constituent of the body (15 to 30 micrograms)

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CYANIDE are white powders and are in common used in many trades . Used in METTALLURGY PHOTOGRAPHY ELECTROPLATING FUMIGATION OF SHIPS AIRCRAFT IN AGRICULTURE FOR SPRAYING TO DESTROY BLIGHT

ACTION ::

ACTION : Cyanide inhibits the action of cytochrome oxidase , carbonic anhydrase and other enzyme systems . It block the final step of oxidative phosphorylation and prevents the formation of ATP and its use as energy source. Cyanide acts by reducing the oxygen carrying capacity of the blood and by combining with the ferric iron atom of intracellular cytochrome oxidase , preventing the uptake of oxygen for cellular respiration Intracellular oxidative process in tissue and it kills by creating histotoxic or cytotoxic anoxia although the blood may contain normal oxygen content

ABSORPTION,METABOLISM& EXCRETION:

ABSORPTION,METABOLISM& EXCRETION INGESTION : -Salts of cyanide releases hydrogen cyanide in stomach due to action of hydrochloric acid and then absorbed as cyanide ion. -It is concentrated in RBC. -Enzyme rhodanase converts them into thiocyanate . This reaction needs sodium thiosulfate . -Some cyanide is converted into cyanocobalamin . Small amounts of cyanide are excreted in breath and sweat INHALATION : -Cyanide gas is rapidly absorbed from respiratory system DERMAL : -Hydrocyanic acid is also absorbed through the skin

MECHANISM OF ACTION:

MECHANISM OF ACTION Cyanide reversibly inhibits ferric ion containing enzymes Cyanide attaches to the iron of the prosthetic group of cytochromic oxidase resulting in disturbance of transport and utilization of oxygen in cells causing a cytotoxic anoxia

Signs and symptoms :

Signs and symptoms This is most rapid of all poison When inhaled as a gas , its action is instantaneous With small dose person 1st experience headache confusion giddiness nausea small loss of muscular power

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MASSIVE DOSES : May produce 1. sudden loss of consciousnes prompt death from respiratory arrest

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CNS : headache vertigo faintness prespiration anxiety excitement confusion drowsiness prostration opisthotonus trismus cramps twitching hyperthermia convulsion epileptiform or tonic which are sometimes localised but usually generalised , paralysis ,stupor , coma and death.

Git::

Git : Bitter acid Burning taste Constriction or numbness of throat Salivation Nausea rarely vomitting RS : Odour of bitter almonds initially tachyapnoea & dyspnoea due to cyanide stimulation of chemoreceptors and the respiratory centre. later rapid slowing of respiratory rate with respiratory depression and cyanosis

Cvs::

Cvs : Hypertension with reflex bradycardia Sinnus arrhythrmia Later tachycardia with hypotension & Cardiovascular collapse Heart continue to beat for several minutes after stoppage of respiration SKIN : 1.PRESPIRATION 2.BULLAE

EYES::

EYES: Glassy &prominent Pupils dilated Unreactive RENAL : 1. ACIDOSIS 2.death occur from respiratory failure 3. In fetal cases more than 1mg of cyanide is found in blood

inhalation ::

inhalation : Constriction about throat and chest Dizziness Loss of consciousness Coma Death Inhalation of air containing 1 part in 2000 of cyanide is fatal immediately 1part in 1000 within few minutes 1part in 5000 within few hours

Chronic poisoning ::

Chronic poisoning : Chronic low level of exposure leads to 1. headache 2.vertigo 3.nausea 4.vomitting 5.diarrhoea 6.chronic cachexia 7.mental distrubance 8.visual defects- scotomata , optic atrophy&psychosis 9. peripheral neuropathy 10. deafness

FATAL DOSE:

FATAL DOSE 50 to 100 mg for hydrocyanic acid 200 to 300 mg for sodium or potassium cyanide 50 to 80 bitter almonds Inhalation of 1 part in 2000- hydrogen cyanide FATAL PERIOD : 2 to 10 minutes sometimes immediate . potassium or sodium cyanide :half an hour. Patient may survive for sevral hours due to delayed absorption .

Mangement::

Mangement : Treatment should be started immediately The principle of the treatment is to reverse the cyanide cytochrome combination INGESTION : gastric lavage with 5% sodium thiosulphate solution ANTIDOTE-amyl nitrate –inhaled Sodium nitrate slowly iv Sodium thiosulphate 25% solution iv

Treatment ::

Treatment : Break o.2ml ampoule of amyl nitrite in a handkerchief &hold over the patients nose for 15 to 30 seconds of every min , until na nitrite infusion is started 2. Both sodium nitrate and sodium thiosulphate can be repeated at the half the intial dose at the end of 1hr if symptoms persist or reappear 3.4 dimethylaminophenol 3mg /kg iv 4.proper ventillation 5.methb more than 50% indication of blood transfusion 6.keep the airway clear 7.patient should be kept under observation for 24 to 48 hrs, as cyanide toxicity may reoccur.

Postmortem appearances::

Postmortem appearances: Eyes : bright , glistening and prominent with dilated pupils Jaws : firmly closed &froth at mouth and nose Cherry red colour of postmortem lividity Bitter almond like smell Bright red colour blood Blood stained froth in trachea and bronchi Congestion of viscera & oedema of lungs Serosal surface may show hemorrhages Stomach mucosa may be eroded and blackened due to formation of alkaline hematin .it is often red and congested . Degenerative changes in nervous system may also occur .

Samples to be preserved for chemical analysis::

Samples to be preserved for chemical analysis: BLOOD ROUTINE VISCERA LUNG BRAIN HEART SPLEEN is considered as best specimen due to prescence of more RBCs

Medicolegal importance ::

Medicolegal importance : Suicidal use of cyanide is not common and is usually limited to specific occupational groups . Suicide with this agent is more common in those persons who are employed in electroplating , chemistry &metal heat treatment & have ready access to this chemical. 2. homicidal – rare 3.accident – industrial /laboratory mishaps 4.embalming interferes with cyanide detection , therefore interpretation in postmortem period becomes difficult

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