Cyanide

Kathleen A. Delaney Sources of. Exposure industrial Exposure Smoke, Inhalation ChronicExposure

Biochemical Toxicology

Clinical Time Course, , of , Poisoning:. , , Routes , of , Exposure Clinical Features

Sy.mp.to.msof Poisoning Pathophysiology T,he„,Mnknown,Exp,osur,e NitroprussideTherapy

Differential Diagnosis Pharmacologic Principles of Treatment

Management Decisions:., Use,of, Spec.i.f.ic,Ant.i.dotes Laboratory Evaluation Disposition Chapter, References

Cyanide is a potent cellular toxin with an infamous history. The ability of extracts of bitter almonds and cherry laurel leaves to cause rapid death has been known for centuries, although the causative agent was not identified as cyanide until the end of the eighteenth century. Cyanide was used in state executions by the ancient Greeks and Romans and, until recently, by the state of California. The first chemist to synthesize hydrogen cyanide gas succumbed dramatically in 1786 when a vial of the gas broke on his laboratory floor. In 1978, hundreds of people died in Jonestown, British Guiana, following a mass suicidal cyanide ingestion.

Cyanide is a simple, highly reactive compound of carbon and nitrogen that has many uses in industry and the chemical laboratory. Its wide availability was emphasized by the experience of investigators who found 65 legitimate sources of cyanide in the Chicago area during attempts to trace the source of cyanide used in the infamous Tylenol-substitution poisonings.1 In nature it is found in large amounts in certain nuts, plants, and fruit pits in the form of cyanogenic glycosides. 2 Tobacco smoke has been estimated to contain from 100 to 1600 parts per million (ppm) of cyanide, and smokers have been shown to have higher levels of cyanide and thiocyanate, a "detoxified" form of cyanide.3 The antihypertensive agent, sodium nitroprusside contains cyanide.

Since it is so ubiquitous in nature, animals have evolved biochemical means of detoxifying cyanide. In humans and many other mammals, the enzyme rhodanese detoxifies cyanide by converting it to thiocyanate, a less toxic form that is excreted by the kidneys.45

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