The avidity with which cyanide binds to metals accounts for its serious physiologic effects in poisoning. Cyanide disrupts metabolism by inhibiting the function of a number of important metal-containing enzymes. Its most dramatic physiologic effects are produced by the disruption of mitochondrial oxidative phosphorylation through the inhibition of cytochrome A3.4U Cytochrome A3 uses trivalent ferric (Fe3+) to catalyse the reduction of molecular oxygen to water, which is the final step in electron transport. Inhibition at this step blocks the ability of body tissues to use oxygen so that only anaerobic metabolism occurs. This inhibitory binding of cyanide to the cytochrome ferric ion is labile and readily reversible.4
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