Introduction

Cyanide is a deadly poison which animals and humans encounter from a number of sources. Cyanide salts and hydrocyanic acid are ubiquitous in industrial and chemical manufacturing such as electroplating, mineral refining, pest control, and tanning of hides. It is well known that cyanide is present naturally in a variety of plants, including apricot, peach, plum, and apple seeds.

Reports indicate that overzealous use of nitroprusside, a potent vasodilator, can lead to cyanide toxicity and death from long-term use. Cyanide is also released in the duodenum after ingestion of the cytotoxin amygdalin.

There is often a combination of carbon monoxide (CO) and cyanide intoxication in victims of fire and smoke inhalation. Cyanide is released in the thermal breakdown of natural fibers (wool and silk), nylon, polyurethane foam, and asphalt ( SaJlkowskilllaodPleo,0®y...1994). Although CO is the more common toxic agent, cyanide has caused death in fire victims without CO intoxication. Since cyanide inhalation may cause diminished strength and co-ordination, a victim's ability to leave the source of the toxin may be impaired. Cyanide poisoning in fire victims may be indicated by the presence of plasma lactate concentrations above 10 mmol/l ( B§Md.eLa.l 1991).

Although cyanide is a diffuse substance in the environment, deaths are uncommon. Many factors may predispose people to developing cyanide toxicity, including poor nutrition status, with a concomitant decrease in the sulfur and albumin pool, and smoking. Vegans, persons who suffer pernicious anemia secondary to vitamin B12 deficiency, or persons with renal or hepatic insufficiency resulting in decreased elimination are also at risk.

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Sleep Apnea

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