Cyanide poisoning
Cyanides (hydrocyanic acid and its salts) are poisonous chemical compounds with a quick and strong toxic effect. They have a characteristic smell of bitter almonds, which, however, cannot be distinguished by about 50% of people.
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Cyanides are used in several industries, such as the extraction of fatty acids, the recovery of gold ore, the manufacture of textiles and plastics, or in electroplating. Small amounts of cyanides are found in the seeds of fruits from the Rosaceae family (peaches, apricots, plums, almonds, cherries). If you eat too many of these seeds, especially bitter almonds, poisoning can occur.
How does cyanide poisoning happen?
Cyanides enter the body through the mucous membranes of the respiratory and digestive system. They are very quickly absorbed, enter the bloodstream and with its current are carried to all tissues.
Cyanides have a strong similarity to ferric iron, and therefore easily replace it in a respiratory enzyme called cellular cytochrome oxidase. As a result, cells lose their ability to utilize oxygen, which leads to the development of tissue hypoxia. The oxygen content in venous blood rapidly increases and becomes practically the same as in arterial blood. This is the reason for the bright scarlet color of the skin and mucous membranes in case of cyanide poisoning.
Oxygen starvation leads to severe damage to the central nervous system, a sharp suppression of the vasomotor and respiratory centers.
Hydrocyanic acid and its compounds in the body are partially destroyed. Their metabolites bind to sulfur ions and are then excreted in feces and urine. In small amounts, cyanide is excreted unchanged through the respiratory tract, which gives the exhaled air a specific smell of bitter almonds.
Poisoning symptoms
The severity of intoxication depends on the concentration of the poison that entered the body and on the route of its entry. So, if the poison was taken orally, then the symptoms of poisoning appear after a few minutes, and when the vapor of hydrocyanic acid is inhaled - almost instantly.
With a high concentration of cyanide, acute poisoning develops with a lightning-fast course. The victim loses consciousness, he suffers from respiratory and cardiac arrest caused by paralysis of the respiratory and vasomotor centers of the medulla oblongata.
If the concentration of the poison is relatively low, 4 stages are distinguished in the clinical picture of cyanide poisoning:
- Initial stage. The victim complains of severe headache and dizziness, a feeling of heaviness in the frontal lobes. He has tachycardia and increased respiratory rate (tachypnea). The skin becomes bright scarlet.
- Dyspnea stage. The respiratory rate slows down. Inhales become noisy and deep. Nausea occurs, followed by vomiting. The pupils dilate. Tachycardia is replaced by bradycardia.
- The stage of seizures. The victim loses consciousness, he has tetanic convulsions. Against their background, a pronounced spasm of the chewing muscles develops, a frequent consequence of which is the biting of the tongue.
- Paralysis stage. There is a loss of skin sensitivity and a sharp suppression of reflexes. Breathing becomes very rare and shallow. Involuntary urination and defecation are observed. The outcome of this stage of cyanide poisoning in the absence of specific therapy is death.
Symptoms of cyanide poisoning develop so quickly that it is often not possible to clearly differentiate one stage of poisoning from another in practice.
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First aid for cyanide poisoning
Correctly and quickly provided first aid significantly increases the chances of survival of a victim of cyanide poisoning.
If the poisoning is associated with the ingress of poison into the body through the respiratory tract, then the victim should be taken out of the room into fresh air as soon as possible. If this is not possible, then it should be laid on the floor, since cyanide vapors are lighter than air and rise up, accumulating under the ceiling of the room.
Clothing is removed from the victim, which could get prussic acid or its compounds. Do not take off clothes over your head so as not to increase the symptoms of poisoning. It is best to cut it.
The skin is washed with soapy water and then clean water.
In case of oral cyanide poisoning, if the victim is conscious, he should urgently induce vomiting. To do this, he is given a few glasses of a 2% solution of baking soda (1 tsp. Soda per 200 ml of water), a 0.1% solution of potassium permanganate (a slightly pink solution) or pure water. Then irritate the root of the tongue with a spoon handle or fingers.
After that, the victim is given warm sweet tea, which reduces the intensity of intoxication.
In case of respiratory arrest, it is impossible to carry out artificial ventilation of the lungs by mouth-to-nose or mouth-to-mouth methods, as this will cause poisoning for the rescuer.
When is medical attention needed?
In case of cyanide poisoning, it is impossible to count on a favorable outcome in the absence of medical care, therefore, an ambulance team should be called as soon as possible or the victim should be delivered to the hospital on his own. This must be done even if the poisoning seems mild.
Treatment for cyanide poisoning begins with the administration of antidotes. They are divided into three groups:
- Glucose. It combines with cyanides, resulting in the formation of non-toxic substances that are excreted from the body naturally. The patient is injected intravenously with hypertonic glucose solutions (10-40%) or given to drink sugar syrup.
- Sodium thiosulfate. When administered intravenously, it promotes the transfer of cyanides into thiocyanides that are safe for the human body.
- Nitroglycerin, Amyl Nitrite, Methylene Blue. When they interact with hydrocyanic acid and its derivatives, the latter are converted into cyanmethemoglobin. This substance has no toxic properties and is naturally excreted from the body.
The introduction of these drugs in the first minutes after cyanide poisoning prevents death, even with very severe intoxication.
In addition, in the hospital, the victims receive oxygen therapy and symptomatic treatment.
Possible consequences
Severe cyanide poisoning is usually quickly fatal. With less severe poisoning in the process of recovery, patients develop persistent damage to the neuropsychic sphere, lability of the pulse and blood pressure.
Prevention
To prevent cyanide poisoning, chemical workers must carefully follow safety requirements.
It is forbidden to eat large quantities of seeds of certain types of fruits, which contain compounds of hydrocyanic acid. It is especially important to explain this rule to children and monitor its implementation.
Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
