Cyanide poisoning

Cyanide may be used in insecticides, photograph development and the production of certain metals. Toxicity results from reversible inhibition of cellular oxidising enzymes

Presentation

• 'classical' features: brick-red skin, smell of bitter almonds
• acute: hypoxia, hypotension, headache, confusion
• chronic: ataxia, peripheral neuropathy, dermatitis

Management

• supportive measures: 100% oxygen
• definitive: hydroxocobalamin (intravenously), also combination of amyl nitrite (inhaled), sodium nitrite (intravenously), and sodium thiosulfate (intravenously)