Cyanide Poisoning and Its Treatment
Rebeca Gracia, Pharm.D., and Greene Shepherd, Pharm.D.
Cyanide is both widely available and easily accessible throughout the world.
Although the compound is not frequently encountered, it has been used as a
poison and contaminant in the past and is a potential terrorist agent.
has the ability to cause significant social disruption and demands special
attention to public health preparedness.
It can be obtained from a variety of
sources, including industrial, medical, and even common household products.
Another frequently encountered source of cyanide exposure is residential
Exposure to high concentrations of the chemical can result in death
within seconds to minutes.
Long-term effects from cyanide exposure can
cause significant morbidity.
The only treatment for cyanide toxicity approved
for use in the United States is a kit consisting of amyl nitrite, sodium nitrite,
and sodium thiosulfate.
Future research aims to find a faster-acting, more
effective, and better tolerated treatment for cyanide toxicity.
cyanide, antidote, poisoning.
Toxic Dose and Onset of Toxicity
Mechanism of Toxicity
Acute Clinical Manifestations
Investigational and Non–U.S.-Approved Antidotes and
Cyanide was used as a poison for centuries
before the chemical was isolated and identified.
Many, and often successful, attempts have been
made throughout history to exploit it as a poison
and contaminant against individuals as well as
Recent events have height-
ened concern about the use of chemical weapons
In addition to being highly toxic,
cyanide exposure can cause significant social
disruption and public panic.
demands special attention to public health
preparedness (e.g., antidote stocking).
treatment for cyanide toxicity approved for use in
the United States is a kit consisting of amyl
nitrite, sodium nitrite, and sodium thiosulfate
(Cyanide Antidote Kit; Acorn Inc., Buffalo Grove,
It was formerly known as the Pasadena or
It is important for health professionals
to be aware of potential sources of cyanide, its
effects and treatment, and investigational as well
as non–U.S.-approved antidotes.
Cyanide is both widely available and easily
accessible in a variety of forms.
cyanide was used as a warfare agent in the
volatile, water-soluble, liquid forms of hydrogen
cyanide and cyanogen chloride.
reactive salt forms are exploited for numerous
industrial applications, including chemical
synthesis, electroplating, tanning, metallurgy,
printing, agriculture, photography, manufacture
of paper and plastics, and for use as fumigants
These salts produce hydrogen
cyanide gas when mixed with strong acid and
thus pose a significant risk in industrial accidents
as well as for intentional exposures.