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Cyanide Poisoning

Cyanide Poisoning is a topic covered in the 5-Minute Emergency Consult.

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  • Toxicity through inhalation, or GI tract absorption
  • Intracellular toxin that inhibits aerobic metabolism through interruption of oxidative phosphorylation:
    • Leads to decreased O2 utilization and ATP production
  • Detoxification:
    • Rhodanese: Hepatic mitochondrial enzyme responsible for the metabolism:
      • Combines cyanide (CN) with sulfur (rate-limiting step) covalently (irreversible) to form less toxic and water-soluble thiocyanate (T-CN)
      • Forms less toxic reversible cyanhemoglobin when combined with hemoglobin (Fe 3+)
      • Forms nontoxic cyanocobalamin (B12) when combined with hydroxocobalamin (B12a)
      • Rate of CN removal requires adequate bioavailability of sulfur compounds (thiosulfate [TS]).


  • Fires:
    • Combustion by-product of natural and synthetic products
  • Industry:
    • Metal plating, microchip manufacturing
    • Chemical synthesis
    • Plastic manufacturing
    • Pesticides
  • Solvents:
    • Artificial nail remover
    • Metal polishes
  • By-product of nitroprusside metabolism (nonenzymatic)
  • By-product of Pseudomonas aeruginosa and pyocyaneus infections
  • Amygdalin (converted by intestinal flora to CN), CN-containing plants (apricot and peach pits, apple and pear seeds, and cassava)
  • Jewelry making

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Rosen, Peter, et al., editors. "Cyanide Poisoning." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307481/all/Cyanide_Poisoning.
Cyanide Poisoning. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307481/all/Cyanide_Poisoning. Accessed April 25, 2019.
Cyanide Poisoning. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307481/all/Cyanide_Poisoning
Cyanide Poisoning [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307481/all/Cyanide_Poisoning.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Cyanide Poisoning ID - 307481 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307481/all/Cyanide_Poisoning PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -