1. |
Sodium cyanide |
Bitter, acrid, burning taste followed by constriction of membrane in throat, salivation and nausea without vomiting, anxiety, confusion and dizziness etc.
Other features are dyspnoea, tachypnoea, pulmonary oedema, bradycardia or tachycardia, hypotension, conduction defects, dysrthythmias, hyperglycaemia, cerebral oedema, convulsions and metabolic acidosis.
There may be bitter almond smell in breath.
Chronic cyanide poisoning can cause ataxia, peripheral neuropathy, optic atrophy and nerve deafness. |
Remove the person from the contaminated environment.
In case of (a) skin contact – Remove all contaminated clothings and immediately wash with lot of water and soap; (b) Eye contamination – Wash the eyes with plenty of cool and clean water; (c) Inhalation – Carry the person to the open fresh air, loosen the clothings around neck and chest, and (d) Ingestion – If the victim is fully conscious, induce vomiting by tickling back of the throat. In case the person is unconscious make sure the breathing passages is kept clear without any obstruction. Victim’s head should be turned to one side in the lying down position. In case of breathing difficulty, give mouth to mouth or mouth to nose breathing.
Medical aid: Take the patient to the doctor/Primary Health Centre immediately along with the original container, leaflet and label. |
Inhalation – If exposed to fumes remove the patient from further exposure. Give 100% oxygen. Establish a clear airway.
Ingestion
Perform gastric lavage
If the patient’s condition is deteriorating establish a clear airway. Give assisted respiration with 0.2 to 0.4 amyl nitrite till other drugs are available. If the systolic blood pressure falls below 80 mm Hg stop further administration of amyl nitrite and start IV fluids immediately.
Other antidotes are (a) give 50 ml of 25% sodium thiosulphate solution (12.5 g) IV over 10 minutes (For children less than 25 kg body weight, the dose of sodium thiosulphate is 1.65 ml/kg of 25% solution) or
(b) 20 ml of dicobalt edetate (kelocyanor) solution (300 mg) IV over one minute, followed by 50 ml of 50% dextrose IV or
(c) 10 ml of 40% hydroxocobalamin solution (4 g) IV over 20 minutes, and 10 ml of 3% sodium nitrite solution (300 mg) IV over 5-20 minutes (For children less than 25 kg b.w., the dose of sodium nitrite is 0.33 ml/kg of 3% solution)
Dicobalt edetate should be administered only when cyanide poisoning is definite; otherwise there is a risk of cobalt toxicity. |
