Toxicology

last updated: September 21, 2016

Cyanide ATP Disruption

Cyanide Toxicity

Cyanide Poisoning

Cyanide Posion Treatment​

  • sodium thiosulfate

  • hydroxocobalamin

  • amyl nitrite

  • cyanocobalamin

  • sodium nitrite

sympathetic

parasympathetic

anti-cholinergic

Anticholinergic (sympathetic)

S/Sx:

  • Hot as a hare: low grade body temperature 

  • Blind as a bat: mydriasis (dilated pupils)

  • Dry as a bone: dry mouth, dry eyes, decreased skin

    • examine axilla and groin (where dryness is uncommon)​

  • Red as a beet: flushed face

  • Mad as a hatter: delirium

    • speech may be soft, mumbling word salad​ (cotton balls in mouth)

    • hallucinations

    • delirium

    • coma

    • seizures

  • sinus tachycardia

  • hypertension

  • decreased bowel sounds

  • constipation

  • urinary retention

Common anticholinergic medications

  • dimenhydrinate (Gravol)

  • low-potency antipsychotics

  • benztropine

  • atropine

  • antihistamines

  • Tricyclic Antidepressants

  • Jimsonweed

  • Amanita muscaria mushrooms

  • Parasympatholytic medications

  • Scopolamine

  • Hyoscyamine

Management

  • benzodiazepines

  • precedex

  • avoid physical restraints

  • rhabdomyolysis

  • avoid antipsychotics

  • control hyperthermia

  • physostigmine

    • anticholinesterase 

    • Obtain EKG prior to administration to rule out Bradycardia, intraventricular conduction delay or AV Nodal block

    • Contraindicated in uncontrolled Asthma or Wheezing

    • Contraindicated in Seizure disorder​

... but I would more especially commend the clinician who, in acute diseases, by which the bulk of mankind are cutoff, conducts the treatment better than others.
 
Hippocrates, 400 BC