This document focuses on the history, use, toxicity, and antidotes of cyanide.
The effects of a high dose of cyanide are quick, and death occurs within minutes. Antidotes are effective if administered in time. Cyanide is present in some foods, in the products of combustion of synthetic materials, and is widely used in industry. The cyanides of military interest are the volatile liquids hydrocyanic acid (hydrogen cyanide, HCN; North American Treaty [NATO] designation: AC) and cyanogen chloride (NATO designation: CK). Since the days of ancient Rome, cyanide and the derivatives of this highly toxic substance have been used as weapons. There has been little use of cyanide by the military; most of the information on cyanide poisoning has been from civilian experience in poisoning, fires, and industrial accidents. The effects from cyanide poisoning are those of progressive histotoxic tissue hypoxia (inadequate oxygen intake). The symptoms, signs, and physical findings are directly related to the dose of cyanide, the route of exposure, and the type of cyanide compound. Cyanogen chloride produces irritation of the eyes and mucous membranes similar to that produced by riot control agents. The principles of therapy are to eliminate further exposure and to institute supportive and specific antidotal therapy. The recommended agents or components of specific antidotal therapies for cyanide poisoning vary according to country and medical custom. In the United States, the antidotes used are sodium nitrite and sodium thiosulfate. These are quite effective if given before cessation of cardiac activity. 85 references