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Cyanide – Effects, Poisoning and Treatment

Cyanide is a highly potent cellular poison that blocks cellular respiration. It occurs naturally in some foods and is also used in various industrial processes.

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Things worth knowing about "Cyanide"

Cyanide is a highly potent cellular poison that blocks cellular respiration. It occurs naturally in some foods and is also used in various industrial processes.

What is Cyanide?

Cyanide refers to a group of chemical compounds containing the cyanide ion (CN⁻). The most well-known form is hydrogen cyanide (HCN), also known as prussic acid – a volatile, highly toxic compound with a characteristic bitter almond odor. Cyanides are among the most potent cellular poisons known and are found both in nature and in industrial settings.

Sources and Occurrence

Natural Sources

Cyanide occurs naturally in the form of cyanogenic glycosides in various plants. These compounds release hydrogen cyanide when chewed or digested. Common sources include:

Bitter almonds and apricot kernels
Cherry, peach, and plum pits
Cassava (manioc) – especially when raw
Raw elderberries
Flaxseed husks

Industrial and Environmental Sources

Industrially, cyanide is used in electroplating, gold extraction, plastics manufacturing, and the pharmaceutical industry. Hydrogen cyanide is also released when nitrogen-containing plastics (e.g., polyurethane, polyacrylonitrile) burn, posing a significant poisoning hazard in fire situations.

Mechanism of Action – How Does Cyanide Affect the Body?

Cyanide acts as an inhibitor of cytochrome c oxidase, a key enzyme in the mitochondrial respiratory chain. It binds irreversibly to the iron(III) ion of the enzyme, blocking the final step of cellular energy production (oxidative phosphorylation). The result is histotoxic hypoxia: cells can no longer utilize oxygen despite adequate supply. Organs with high energy demands – particularly the heart and brain – are most severely affected.

Symptoms of Cyanide Poisoning

The symptoms of cyanide poisoning depend on the amount absorbed and appear rapidly:

Mild poisoning: Headache, dizziness, nausea, vomiting, rapid heartbeat
Moderate poisoning: Confusion, anxiety, severe weakness, drop in blood pressure
Severe poisoning: Loss of consciousness, seizures, cardiac arrhythmia, respiratory arrest, death

A characteristic sign is that venous blood may appear bright red, as oxygen is not consumed by the cells. A bitter almond odor on the breath may also be detectable.

Diagnosis

The diagnosis of cyanide poisoning is made clinically based on symptoms, exposure history (e.g., fire incident, ingestion of suspicious substances), and laboratory findings. Key indicators include:

Elevated blood lactate levels (lactic acidosis) indicating anaerobic metabolism
Reduced arteriovenous oxygen difference (oxygen is not being utilized)
Direct measurement of cyanide in blood (available in specialized laboratories)

Treatment of Cyanide Poisoning

Cyanide poisoning is a medical emergency requiring immediate action:

Immediate Measures

Remove the person from the hazardous area (ensure personal safety)
Call emergency services immediately
If unconscious: recovery position or CPR as needed
Avoid mouth-to-mouth resuscitation without a protective mask

Medical Antidotes

Hydroxocobalamin (a precursor to Vitamin B12): Binds cyanide ions to form non-toxic cyanocobalamin – first-line treatment
4-DMAP (4-dimethylaminophenol): Induces methemoglobin formation which binds cyanide – fast-acting but with notable side effects
Sodium thiosulfate: Promotes conversion of cyanide to the less toxic thiocyanate
High-flow oxygen: Supports treatment by optimizing oxygen delivery

Cyanide in Food – An Everyday Health Risk?

Occasional consumption of small amounts of cyanogenic foods (e.g., a single apricot kernel) is generally harmless for healthy adults, as the body can detoxify small amounts of cyanide via the enzyme rhodanese. However, the European Food Safety Authority (EFSA) and various national health agencies advise against consuming bitter apricot kernels and recommend avoiding products with high cyanide content. Children, pregnant women, and individuals with impaired liver function are particularly at risk.

References

Borron SW, Baud FJ: Antidotes for acute cyanide poisoning. In: Current Opinion in Pharmacology, 2012; 12(3): 209–217.
World Health Organization (WHO): Cyanide in Drinking-water – Background document for development of WHO Guidelines for Drinking-water Quality. Geneva, 2004.
European Food Safety Authority (EFSA): Acute health risks related to the presence of cyanogenic glycosides in raw apricot kernels and products derived from raw apricot kernels. EFSA Journal, 2016; 14(4): 4424.

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