Acute cyanide Intoxication: A rare case of survival

Abstract

A 30-year-old male jewellery factory worker accidentally ingested silver potassium cyanide and was brought to the emergency department in a state of shock and profound metabolic acidosis. This patient was managed hypothetically with use of injection thiopentone sodium intravenously until the antidote was received. Cyanide is a highly cytotoxic poison and it rapidly reacts with the trivalent iron of cytochrome oxidase thus paralysing the aerobic respiration. The result is severe lactic acidosis, profound shock, and its fatal outcome. The patient dies of cardio-respiratory arrest secondary to dysfunction of the medullary centres. It is rapidly absorbed, symptoms begin few seconds after exposure and death usually occurs in <30 min. The average lethal dose for potassium cyanide is about 250 mg. We used repeated doses of thiopentone sodium till the antidote kit was finally in our hands, hypothesising that it contains thiol group similar to the antidote thiosulphate. Moreover, it is an anticonvulsant. We were successful in our attempts and the patient survived though the specific antidotes could be administered after about an hour.

Development of magnetic carbon nanotubes for dispersive micro solid phase extraction of the cyanide metabolite, 2-aminothiazoline-4-carboxylic acid, in biological samples

“…Cyanide is infamous for its swift and deadly effects attributed to its uses as a chemical warfare agent and the association of numerous accidental and intentional deaths [1][2][3][4][5][6][7]. In 2016, 198 cyanide exposure cases were reported in the United States, of which, nearly 70% were unintentionally exposed and more than 8% were due to intentional poisoning [8].…”

“…In 2016, 198 cyanide exposure cases were reported in the United States, of which, nearly 70% were unintentionally exposed and more than 8% were due to intentional poisoning [8]. Although accidental exposure to cyanide is primarily caused by consumption of the seeds and roots of certain plants [4,[9][10][11], it is commonly encountered in industrial workers who have access to cyanide salts [3,12] and in smokers and fire victims due to the inhalation of cyanide-containing smoke [13][14][15]. Confirmation of cyanide exposure is an important task for clinical diagnosis, workplace safety, environmental monitoring, and forensics.…”

Differential oxidative stress thresholds distinguishes cellular response to vascular occlusion and chemotoxicityin vivo

“…CcOX represents the complex V of the electron transport chain and is responsible for the conversion of molecular oxygen to water in the mitochondria (Ashe et al, 2014;Bhattacharya et al, 2014;Jethava et al, 2014). In addition, the binuclear center of CcOX has a high affinity for oxygen, and cyanide when present; such that CN À in the mitochondria binds the binuclear center and reduces the oxygen conversion capacity of CcOX.…”

Accidental ingestion of traces of cyanide: A clinical experience

“…There have been several reports of fatal and near-fatal cases of cyanide poisoning among the jewelry industry workers from India and other countries. [ 1 2 ] The jewelry workers who use potassium cyanide to polish silver and gold are at a risk of ingesting cyanide which is otherwise not easily available to the general public either with suicidal intention or by accident. In a study on acute cyanide poisoning among jewelry and textile industry workers, Coentrão and Moura[ 3 ] have reported many instances of victims surviving following cyanide poisoning due to accidental ingestion.…”

“…The patient may quickly deteriorate into deep coma, hypotension, bradycardia, convulsions, and finally cardiorespiratory arrest as the result of dysfunction of the medullary centers in <30 min. [ 1 4 ] The diagnosis and treatment of cyanide poisoning is mostly based on the circumstantial evidence as very little time is available for the clinicians to react. [ 1 2 ] It is documented that at much lower concentrations of cyanide, the patient could present with numbness, weakness, vertigo, nausea, and rapid pulse as seen in our patient.…”