Ramathibodi Poison Center Faculty of Medicine , Ramathibodi Hospital Mahidol University

Cyanide Poisoning

cyanide poisoning cyanide cyanide NaCN, KCN, Ca(CN)2 cyanide 1 cyanide cyanide cyanide cyanogenic glycoside linamarin cyanide

Cyanide electron transport mitochondria anoxia (histotoxic anoxia) ( 1) hypoxia cyanide hypoxia central cyanosis cyanide venous oxygen cyanide hemoglobin cyanohemoglobin central cyanosis eye ground retinal vein retinal artery retinal vein artery eye ground blood gas study arterial mixed venous blood O2 tension tissue O2

cyanide central cyanosis central cyanosis cardiovascular collapse bitter almond 40% 2

cyanide cyanide cyanide 3 lactic acidosis hypoxia arterial blood gas () cyanide supportive treatment specific treatment

Supportive treatment

1. Establish airway intubate O2 PaO2 hypoxia hypoventilation tissue O2 mouth to mouth resuscitation cyanide antidote

2. hypotension start IV fluid, maintain BP fluid load vasopressor

3. severe acidosis pH

sodium thiosulfate antidote dicobalt edetate cyanide ion cobalt cyanide monocobalt edetate 2 approved FDA hydroxocobalamin

1. Kerns II WP, Kirk MA. Cyanide and hydrogen sulfide. In: Goldfrank LR, Flomebaum NE, Lewin NA, et al (eds). Goldfranks toxicologic emergencies. 5th ed. Connecticut: Appleton & Lange, 1994:1215-29.

2. Hall AH, Linden CH, Kulig KW, Rumack BH. Cyanide poisoning from laetrile poisoning: Role of nitrite therapy. Pediatrics 1986;78:269-72.

3. Poisindex staff editorials. Cyanide. Poisindex Micro -medex: Denver 1998. 4. Hall AH, Rumack BH. Clinical toxicology of cyanide. Ann Emerg Med

1986;15(9):1067-74. 5. Bermudez RA, Romero AM, Belzunegui MVG, Lorite AB, Cabrera CA. Venous blood

arteriolization and multiple organ failure after cyanide poisoning. Intensive Care Med 1997;23:1286.