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Deaths Due to Asphyxiant Gases
Published in Sudhir K. Gupta, Forensic Pathology of Asphyxial Deaths, 2022
Hydrogen cyanide (HCN) and its salts are potentially deadly and rapidly-acting chemical asphyxiants causing painless and quick death. HCN is a chemical compound of carbon and nitrogen having triple bond. Inorganic cyanides like sodium cyanide, potassium cyanide are potentially dangerous than organic cyanides and are usually called as nitrile-like acetonitrile as these nitriles don't release cyanide ion. It can exist as gas (HCN) as well as solid (salts of sodium and potassium cyanide-white, crystalline powder). When HCN is dissolved in water, hydrocyanic acid is formed which is a colorless volatile liquid and is extremely toxic. Cyanide has a peculiar bitter almond odor and is a cytotoxic poison. The ability to smell cyanide is genetically governed and is a sex-linked recessive trait. Therefore, not everybody can smell it.
Asphyxia due to Metabolic Poisons
Published in Burkhard Madea, Asphyxiation, Suffocation,and Neck Pressure Deaths, 2020
Hydrogen cyanide is an extremely toxic gas (or liquid – hydrocyanic acid), which prevents tissue utilization of oxygen by binding to cytochrome oxidase, resulting in inhibition of cellular respiration. This binding occurs very rapidly and may cause death within minutes [22]. The expectation of a rapid death is probably a major reason for the ingestion of cyanide salts to commit suicide. However, the availability of hydrogen cyanide is limited and therefore such suicides are mostly seen in groups with ready access to it, such as scientists, jewellers and metal workers, a pattern that has been reported for decades and still remains unchanged [10]. Despite the awareness of its toxicity, workplace exposure causing non-intentional poisoning continues to contribute to the cyanide death toll. In addition, hydrogen cyanide can be formed in toxic concentrations in fires, and even if certain plastics have been banned because of a high production of cyanide upon combustion, many fire victims still show high blood cyanide levels. The high toxicity has also attracted interest by terrorists, and several attempts of mass killings have been reported, the most well-known being that in a Tokyo underground station in 1995, where bags of sulfuric acid and sodium cyanide were found in a restroom. When mixed, these would produce deadly hydrogen cyanide (HCN) gas.
Chemical injuries
Published in Jan de Boer, Marcel Dubouloz, Handbook of Disaster Medicine, 2020
The initial treatment of chemical asphyxiants includes the removal of the casualties from the source of exposure concurrent with basic and advanced life support as needed. If the exposure is not immediately lethal and ventilatory support is provided, recovery can be expected in most victims. Several of those toxins do have antidotes, which should be administered as soon as possible. Oxygen is the cornerstone of treatment, especially in carbon monoxide poisoning; consequently, the administration of 100 percent oxygen should be initiated as soon as the diagnosis is suspected. Antidote therapy in hydrogen cyanide poisoning is indicated for any patient with more than minor symptoms, as represented by restlessness, anxiety or hyperventilation23. Standard antidotes include amyl nitrite, sodium nitrite and sodium thiosulphate. However, the administration of these antidotes is quite demanding in mass casualty situations and the use of hydroxycobalamine or di-cobaltethylenediamine is more justified13,55.
Development of sodium tetrathionate as a cyanide and methanethiol antidote
Published in Clinical Toxicology, 2022
Adriano Chan, Jangwoen Lee, Subrata Bhadra, Nesta Bortey-Sam, Tara B. Hendry-Hofer, Vikhyat S. Bebarta, Sari B. Mahon, Matthew Brenner, Brian Logue, Renate B. Pilz, Gerry R. Boss
Cyanide is a well-known toxic chemical. It is generated as hydrogen cyanide gas in structural fires and is a major contributor to death by smoke inhalation [1]. It is used in a variety of industries, with over three billion pounds of cyanide salts produced annually worldwide [2]. It has the potential to be released by terrorists and is considered a high-priority chemical threat by the Center for Disease Control. Currently approved treatments for cyanide poisoning in the United States are hydroxocobalamin and the combination of sodium nitrite and sodium thiosulfate. Both treatments must be given intravenously over 10–15 min, which would not be practical in the setting of a major fire, industrial accident, or terrorist attack. A treatment is needed that can be given quickly, for example by intramuscular injection using an autoinjector. This requires that the drug is sufficiently potent and soluble that it can be administered in a small volume.
Development of a hydrogen cyanide inhalation exposure system and determination of the inhaled median lethal dose in the swine model
Published in Inhalation Toxicology, 2018
Jillian M. Staugler, Michael C. Babin, M. Claire Matthews, Matthew K. Brittain, Mark R. Perry
Cyanide is a highly volatile compound with toxic effects known for thousands of years. Cyanide exposure in humans can occur from diet, occupation or fire (Jackson & Logue, 2017; Simeonova et al., 2004). It is produced naturally as a self-defense mechanism in organisms such as bacteria, algae, fungi and plants, as well as anthropogenically during industrial processes (Jackson & Logue, 2017; Simeonova et al., 2004). Naturally occurring cyanide can lead to the ingestion of cyanogenic plants by wildlife or humans (Knowles, 1976). Occupational hazards include mining and metal processing (Mudder & Botz, 2004), plastic production, fiber fabrication, cosmetics, photography, pharmaceuticals and pest control (Baskin & Brewer, 1997; Jackson & Logue, 2017). Combustion of natural and synthetic materials, as found in structure fires or cigarette smoke, produces hydrogen cyanide (HCN) gas (Baud et al., 1991; Mahernia et al., 2015; Silverman et al., 1988).
Modest and variable efficacy of pre-exposure hydroxocobalamin and dicobalt edetate in a porcine model of acute cyanide salt poisoning
Published in Clinical Toxicology, 2020
Adrian Thompson, Michael Dunn, Robert D Jefferson, Kosala Dissanayake, Frances Reed, Rachael Gregson, Stephen Greenhalgh, R Eddie Clutton, Peter G Blain, Simon HL Thomas, Michael Eddleston
Hydrogen cyanide and cyanide salts are highly toxic industrial chemicals that may be used in terrorist attacks [1–3]. Dicobalt edetate and hydroxocobalamin are two established and widely used antidotes [4–10]. Dicobalt edetate is the licenced UK antidote and has been used since Paulet’s work on cyanide antidotes in the 1950s [11]. Hydroxocobalamin has been introduced more recently [6]. Few data are available on their comparative efficacy and no randomised controlled trials have been performed in humans. Analysis of their binding capacity suggests that they bind only modest quantities of cyanide (Box 1); however, it is possible that small reductions in free cyanide concentration may be clinically beneficial.