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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