becoming a better Clinician
Toxicology
last updated: September 21, 2016
Cyanide ATP Disruption
Cyanide Toxicity
Cyanide Poisoning
Cyanide Posion Treatment
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sodium thiosulfate
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hydroxocobalamin
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amyl nitrite
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cyanocobalamin
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sodium nitrite

sympathetic
parasympathetic
anti-cholinergic
Anticholinergic (sympathetic)
S/Sx:
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Hot as a hare: low grade body temperature
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Blind as a bat: mydriasis (dilated pupils)
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Dry as a bone: dry mouth, dry eyes, decreased skin
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examine axilla and groin (where dryness is uncommon)
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Red as a beet: flushed face
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Mad as a hatter: delirium
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speech may be soft, mumbling word salad (cotton balls in mouth)
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hallucinations
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delirium
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coma
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seizures
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sinus tachycardia
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hypertension
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decreased bowel sounds
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constipation
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urinary retention
Common anticholinergic medications
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dimenhydrinate (Gravol)
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low-potency antipsychotics
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benztropine
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atropine
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antihistamines
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Tricyclic Antidepressants
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Jimsonweed
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Amanita muscaria mushrooms
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Parasympatholytic medications
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Scopolamine
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Hyoscyamine
Management
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benzodiazepines
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precedex
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avoid physical restraints
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rhabdomyolysis
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avoid antipsychotics
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control hyperthermia
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physostigmine
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anticholinesterase
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Obtain EKG prior to administration to rule out Bradycardia, intraventricular conduction delay or AV Nodal block
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Contraindicated in uncontrolled Asthma or Wheezing
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Contraindicated in Seizure disorder
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