Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 38-31: Cyanide Poisoning + Key Features Download Section PDF Listen +++ ++ Cyanide is rapidly absorbed by inhalation, skin absorption, ingestion In gaseous form, hydrogen cyanide is an important component of fire smoke Cyanide-generating glycosides also found in the pits of apricots and other related plants Cyanide is generated by breakdown of nitroprusside; poisoning can result from rapid high-dose infusions Also formed by metabolism of acetonitrile, found in some over-the-counter fingernail glue removers + Clinical Findings Download Section PDF Listen +++ ++ Onset of toxicity is nearly instantaneous after inhalation However, it may be delayed for minutes to hours after ingestion of cyanide salts or cyanogenic plants or chemicals Effects include Headache Dizziness Nausea Abdominal pain Anxiety Confusion Syncope Shock Seizures Coma Death "Bitter almond" odor may be detected on the victim's breath or in vomitus, although this is not a reliable finding + Diagnosis Download Section PDF Listen +++ ++ The venous oxygen saturation may be elevated (> 90%) in severe poisonings because tissues have failed to take up arterial oxygen Obtain blood cyanide levels (not usually readily available) + Treatment Download Section PDF Listen +++ ++ Remove the victim from exposure, taking care to avoid exposure to rescuers Activated charcoal Administer 60–100 g mixed in aqueous slurry orally or via gastric tube Do not use for comatose or convulsing patients unless they are endotracheally intubated At the scene, induce emesis if charcoal is not immediately available Stop or slow the nitroprusside infusion rate for suspected cyanide toxicity In the United States, there are prepackaged cyanide antidotes (eTable 38–1) ++Table Graphic Jump LocationeTable 38–1.Currently available cyanide (CN) antidote kits.View Table||Download (.pdf)eTable 38–1. Currently available cyanide (CN) antidote kits. Antidote Contents Action Conventional cyanide antidote kit1 Administer 3% sodium nitrite solution, 10 mL intravenously followed by 25% sodium thiosulfate solution, 50 mL intravenously (12.5 g) Nitrites induce methemoglobinemia, which binds CN; thiosulfate hastens CN conversion to less toxic thiocyanate Cyanokit2 Hydroxocobalamin 5 g in two 2.5-g vials Converts CN to cyanocobalamin (vitamin B12) 1In the United States, manufactured by Taylor Pharmaceuticals.2Manufactured by EMD Pharmaceuticals.