Cyanide poisoning

Cyanide is a rapidly acting substance that is traditionally known as a poison. The fatal dose also very low.
Cyanide can exist as a gas, hydrogen cyanide, a salt, potassium cyanide. Natural substances in some
foods such as lima beans, almonds can release cyanide. All known Manioc species contain cyanogens.
Cyanide is also found in manufacturing and industrial sources such as insecticides, photographic
solutions, and jewelry cleaners. It has been used as a poison in mass homicides and suicides. During
World War II, the Nazis used cyanide as an agent of genocide in gas chambers.

Cyanide can be liberated during the combustion of products containing both carbon and nitrogen. These
products include wool, silk, polyurethane (insulation/upholstery), polyacrylonitriles (plastics), melamine
resins (household goods), and synthetic rubber. Vehicular fires can also expose victims to cyanide.
Smoke is the killer in 60% to 80% of all fire deaths. (Not the burns)

Cyanide capsules used by terrorists also a source of poisoning.

If the hydrogen cyanide was inhaled, the victim might detect a bitter almond odor, which is detectable
by approximately 60% of the population (X linked recessive).

Circumstances
1) Suicide
 Ingestion by laboratory workers
 Biting of cyanide capsules by terrorists when captured
 Mass suicides among religious sects
2) Accidental
 Faculty fumigation techniques
 Laboratory accidents
 Ingestion of plant material (Manihot utilissmia)
3) Homicidal
 Introduced into food and drink
 War gas used during World War 1
 Judicial Execution by gassing with cyanide
 Gas Chambers of Hitler in Germany during World War II

Routes of poisoning
1) Inhalation of cyanide gas or its equivalents
2) Ingestion
 The ingested salt is usually potassium cyanide. This combines with gastric hydrochloric
acid to liberate hydrogen cyanide gas
 Ingestion of plant material such as Manihot utilissimia and Adenia palmata
3) Skin Absorption

Toxicology analysis may be difficult to interpret because of destruction and production of CN in the dead
body even in stored blood until analysis is done. (Spurious formation)
Mechanism of action (two folds)
Cyanide only acts as only free hydrogen cyanide and so swallowed salt need to meet either with water
or gastric acid before liberating HCN.

a. A form of histotoxic hypoxia because the cells of an organism are unable to create ATP primarily
through by the inhibition of the mitochondrial enzyme cytochrome c oxidase. (Cyanide
combines with the ferric iron atom of the enzyme cytochrome c oxidase).
b. Local action on the stomach and upper GIT because of the corrosive and irritant effect. The
corrosive effect is due to alkaline nature of the fresh cyanide salt.

PM features and diagnosis

1) Odor of bitter almonds on entering the autopsy room, while carrying out the external
examination of the body, opening into the body cavities and mainly on opening the stomach and
smelling the stomach contents.
2) Bright red or brick red colour of the skin, hypostatic areas, blood, muscles and vascular organs.
This is due to presence of excessive amounts of oxyhaemoglobin in the blood.
3) Diffusely red mucosa of stomach or at times the mucosa of oesophagus, duodenum and
jejunum. Gastric mucosa should not be confused with velvety red appearance which is seen in
arsenic poising.
4) Blackened corrosive patches in gastric mucosa can be seen when fresh salt is ingested
5) Presence of remnants of the capsule in the mouth with cut injuries to gums tongue and buccal
mucosa
6) Presence of powder, part of cyanide capsule & plant materials in the stomach and GI tract
7) Toxicology
 If no proper sample available Stomach contents, intestinal contents, blood, urine,
vomitus, lavage fluid, organs such as liver kidney spleen and brain are send for analysis
along with the remnants of the suspect “food or drink”
 If death is due to inhalation of cyanide then in addition to above lungs should be sent in
a sealed nylon bag