Symptoms and Signs/Empiric Treatment
RECOGNIZE the Symptoms and Signs of Cyanide Poisoning
Progression of symptoms depends on time elapsed since exposure and concentration of exposure.3,4,16
Progression of Symptoms4,29,30
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- In smoke inhalation victims, soot around mouth, nose, and/or back of mouth is also suggestive of cyanide toxicity4,29
- Plasma lactate levels equal to or greater than 10 mmol/L (in smoke inhalation victims) or equal to or greater than 8 mmol/L (non-smoke inhalation victims) is
indicative of cyanide poisoning29
- Other signs include: mydriasis (abnormally dilated pupils); hypertension (high blood pressure) and/or then hypotension (low blood pressure); tachypnea (rapid breathing) or hyperpnea (fast, deep breathing) early; bradypnea (slow breathing), or apnea (stop breathing) late; cardiovascular collapse29
Cyanide is a fast-acting poison—rapid recognition and antidotal therapy can save lives31
- Laboratory tests are not widely available to confirm acute cyanide (CN) poisoning within the time period necessary to intervene29,31
- Without treatment, death can occur within seconds to hours31
- CN exposure can occur by inhalation, dermal exposure, ingestion, or parenteral administration30
- In a terrorist incident, cyanide can be released as a gas in an enclosed space, liberated in an explosion or fire, or introduced into medications as
well as the food and water supply15,32
Diagnosis is made by clinical observation — assessment of symptoms and signs of CN poisoning31
Treatment must be empiric
- Empiric treatment of the casualties of an acute chemical emergency is of paramount importance31
- Well-organized emergency medical response systems, with personnel trained to recognize symptoms and provide supportive intervention, are key to
improving outcomes in cyanide poisoning victims31
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