Acute intoxication is lethal if not immediately diagnosed and treated within 30 minutes. Mode of poisoning is usually inhalation of smoke, absorption from contaminated skin; accidental oral ingestion is less common.
Population at risk include those working in photography, electroplating, chemical, plastic industries and those involved in polishing of gold and silver jewellery. Diagnosis is difficult and is usually based on circumstantial evidence. It is mandatory for emergency department of each hospital as well as the employer to be well equipped with antidote kit and first aid provision for timely management of such cases. We are reporting a case of acute cyanide intoxication managed with symptomatic support and administration of intravenous thiopentone sodium till the antidote kit was available which took almost minutes.
A healthy male aged 30 years working in a jewellery factory was brought to the emergency department approximately 10 min after accidental ingestion of cyanide. On admission, he was in severe shock. He was immediately resuscitated and put on mechanical ventilation. Arterial blood gas ABG report revealed high anion gap metabolic acidosis and injection sodium bicarbonate was given stat and infusion was started.
Meanwhile, the attendants confirmed the substance ingested was silver potassium cyanide used to polish metal plates required for artificial jewellery. The source of poisoning was the beverage tea , which was kept open nearby thus unknowingly got contaminated. Its antidotes were not available at any of the nearby pharmacy and patient was not improving. The patient's attendants were asked to go to the same factory he was working in, for seeking the antidote kit.
Suddenly patient started having convulsions hence injection thiopentone sodium was administered intravenous iv. Total dose of mg was needed over a period of min. Patient's vitals were stable. There were no convulsions.
By this time attendants were back with the antidote kit. And mean B. After 2 h ABG was repeated and there was marked improvement in metabolic acidosis. After 24 h patient was haemodynamicaly stable, was given weaning trial and was extubated. He was shifted to ward, 48 h after admission to Intensive Care Unit and sent home after 5 days of admission to hospital. Cyanide is a rapidly acting and highly toxic chemical and its acute intoxication is fatal.
Many inorganic cyanide salts are used in the following industries:. After discussing your symptoms, your doctor will perform a physical exam. The first step to treating a suspected case of cyanide poisoning is to identify the source of exposure. This will help your doctor or other healthcare provider determine the appropriate decontamination method. In the case of a fire or other emergency incident, rescue personnel will use protective gear like face masks, eye shields, and double gloves to enter the area and take you to a safe location.
If you have ingested cyanide, you may be given activated charcoal to help absorb the toxin and safely clear it from your body. Cyanide exposure can affect oxygen intake, so your doctor may administer percent oxygen via a mask or endotracheal tube.
The cyanide antidote kit consists of three medications given together: amyl nitrite, sodium nitrite, and sodium thiosulfate. The amyl nitrite is given by inhalation for 15 to 30 seconds, while sodium nitrite is administered intravenously over three to five minutes. Intravenous sodium thiosulfate is administered for about 30 minutes. Hydroxocobalamin will detoxify cyanide by binding with it to produce nontoxic vitamin B This medication neutralizes cyanide at a slow enough rate to allow an enzyme called rhodanese to further detoxify cyanide in the liver.
If you suspect you or a loved one is experiencing symptoms of severe cyanide poisoning, seek immediate emergency medical attention. Your outlook will depend on the type of cyanide present, the dose, and how long you were exposed.
Early diagnosis and treatment are key to reducing your risk of complications. Moderate levels of acute or chronic exposure may also be resolved with quick diagnosis and treatment.
The central nervous system CNS and cardiovascular systems are chiefly affected. Signs and symptoms of cyanide poisoning include the following:. Cardiovascular : decreased inotropy, bradycardia followed by reflex tachycardia, hypotension, and pulmonary edema; and.
Survivors may suffer Parkinson's disease, ataxia, optic atrophy, and other neurological disorders. Cyanide intoxication is largely a clinical diagnosis; however, several laboratory features are suggestive:. Cyanide blood levels are confirmatory, as results are not obtainable in time for initial diagnosis. There are some reports of use of rapid calorimetric paper test strips to confirm the presence of cyanide.
Before cyanide antidote can be administered, the patient must be removed from the cyanide-laden area, clothing removed, and skin washed with soap and water. If cyanide salts have been ingested, activated charcoal may prevent absorption from the gastrointestinal tract.
There are 2 major modalities of treatment: the cyanide antidote kit and hydroxocobalamin. Although recovery from a chemical attack is rare, victims may survive sub-lethal exposures, whether from ingestion, smoke inhalation, or exposure to cyanide-containing industrial products, such as carpet.
Patients who are treated successfully for cyanide poisoning should be observed for development of long-term neuropsychiatric symptoms that are similar to symptoms experienced by survivors of cardiac arrest or carbon monoxide poisoning. Who We Are. Clinicians' Biosecurity News. Long-term health effects of exposure to cyanide Survivors of serious cyanide poisoning may develop heart, brain and nerve damage.
How you can protect yourself, and what to do if you are exposed to cyanide Since breathing it is likely to be the primary route of exposure to cyanide, leave the area where the cyanide gas was released and get to fresh air. Quickly moving to an area where fresh air is available is highly effective in reducing exposure to cyanide gas.
If the cyanide gas was released outdoors, move away from the area where it was released. If you cannot get out of the area where the cyanide gas was released, stay as low to the ground as possible. If the release of cyanide gas was indoors, get out of the building. For more information on evacuation during a chemical emergency, see Facts About Evacuation.
For more information on sheltering in place during a chemical emergency, see Facts About Sheltering in Place. If you think you may have been exposed to cyanide, you should remove your clothing, rapidly wash your entire body with soap and water, and get medical care as quickly as possible. Removing your clothing: Quickly take off clothing that may have cyanide on it.
Any clothing that has to be pulled over the head should be cut off the body instead of pulled over the head. If you are helping other people remove their clothing, try to avoid touching any contaminated areas, and remove the clothing as quickly as possible. Washing yourself: As quickly as possible, wash any cyanide from your skin with large amounts of soap and water.
Washing with soap and water will help protect people from any chemicals on their bodies. If your eyes are burning or your vision is blurred, rinse your eyes with plain water for 10 to 15 minutes. If you wear contacts, remove them and put them with the contaminated clothing. Do not put the contacts back in your eyes even if they are not disposable contacts.
If you wear eyeglasses, wash them with soap and water. You can put your eyeglasses back on after you wash them.
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