cyanide poisoning

If hydrogen cyanide is inhaled, it can cause a coma with seizures, apnea, and cardiac arrest, with death following in a matter of seconds. At lower doses, loss of consciousness may be preceded by general weakness, dizziness, headaches, vertigo, confusion, and perceived difficulty in breathing. At the first stages of unconsciousness, breathing is often sufficient or even rapid, although the state of the person progresses towards a deep coma, sometimes accompanied by pulmonary edema, and finally cardiac arrest. A cherry red skin color that darkens may be present as the result of increased venous hemoglobin oxygen saturation. Despite the similar name, cyanide does not directly cause cyanosis.{{cite book |last1=Bhagavan |first1=N. V. |url=https://www.sciencedirect.com/topics/neuroscience/cyanide-poisoning |title=Essentials of Medical Biochemistry |last2=Ha |first2=Chung-Eun Ha |date=2015 |edition=Second |access-date=10 November 2022}} A fatal dose for humans can be as low as 1.5 mg/kg body weight.{{cite web |url=https://www.hc-sc.gc.ca/ewh-semt/pubs/water-eau/cyanide-cyanure/index-eng.php |title=Cyanide [Technical document – Chemical/Physical Parameters] |publisher=Health Canada |url-status=live |archive-url=https://web.archive.org/web/20090204194042/https://hc-sc.gc.ca/ewh-semt/pubs/water-eau/cyanide-cyanure/index-eng.php |archive-date=4 February 2009 |date=6 October 2008 }} Other sources claim a lethal dose is 1–3 mg per kg body weight for vertebrates.{{cite journal|pmid=4313082|year=1969|last1=Oke|first1=O. L.|title=The role of hydrocyanic acid in nutrition|journal=World Review of Nutrition and Dietetics|volume=11|pages=170–98|doi=10.1159/000387578|isbn=978-3-8055-0662-5}}

Exposure to lower levels of cyanide over a long period (e.g., after use of improperly processed cassava roots; cassava is a staple food in various parts of West Africa) results in increased blood cyanide levels, which can result in weakness and a variety of symptoms, including permanent paralysis, nervous lesions,{{cite journal |vauthors=Soto-Blanco B, Maiorka PC, Gorniak SL |title=Effects of long-term low-dose cyanide administration to rats |journal=Ecotoxicology and Environmental Safety |volume=53 |issue=1 |pages=37–41 |year=2002 |pmid=12481854 |doi=10.1006/eesa.2002.2189|bibcode=2002EcoES..53...37S }}{{cite journal |vauthors=Soto-Blanco B, Stegelmeier BL, Pfister JA, etal |title=Comparative effects of prolonged administration of cyanide, thiocyanate and chokecherry (Prunus virginiana) to goats |journal=Journal of Applied Toxicology |volume=28 |issue=3 |pages=356–63 |year=2008 |pmid=17631662 |doi=10.1002/jat.1286 |s2cid=15303657 |url=https://naldc-legacy.nal.usda.gov/naldc/download.xhtml?id=15073&content=PDF |access-date=29 December 2018 |archive-date=22 March 2020 |archive-url=https://web.archive.org/web/20200322171444/https://naldc-legacy.nal.usda.gov/naldc/download.xhtml?id=15073&content=PDF |url-status=live }}{{cite journal |vauthors=Soto-Blanco B, Maiorka PC, Gorniak SL |title=Neuropathologic study of long term cyanide administration to goats |journal=Food and Chemical Toxicology |volume=40 |issue=11 |pages= 1693–1698 |year=2002 |pmid=12176095 |doi=10.1016/S0278-6915(02)00151-5}} hypothyroidism, and miscarriages.{{cite journal |vauthors=Soto-Blanco B, Gorniak SL |title=Prenatal toxicity of cyanide in goats—a model for teratological studies in ruminants |journal=Theriogenology |volume=62 |issue=6 |pages=1012–26 |year=2004 |pmid=15289044 |doi=10.1016/j.theriogenology.2003.12.023}}{{cite journal |author=Soto-Blanco B, Pereira, Verechia FT|title=Fetal and maternal lesions of cyanide dosing to pregnant goats |journal=Small Ruminant Research |volume=87 |issue=1–3 |pages=76–80 |year=2009 |doi=10.1016/j.smallrumres.2009.09.029|display-authors=etal|doi-access=free }} Other effects include mild liver and kidney damage.{{cite journal |vauthors=Sousa AB, Soto-Blanco B, Guerra JL, Kimura ET, Gorniak SL |title=Does prolonged oral exposure to cyanide promote hepatotoxicity and nephrotoxicity? |journal=Toxicology |volume=174 |issue=2 |pages=87–95 |year=2002 |pmid=11985886 |doi=10.1016/S0300-483X(02)00041-0|bibcode=2002Toxgy.174...87S }}{{cite journal |vauthors=Manzano H, de Sousa AB, Soto-Blanco B, etal |title=Effects of long-term cyanide ingestion by pigs |journal=Veterinary Research Communications |volume=31 |issue=1 |pages=93–104 |year=2007 |pmid=17180454 |doi=10.1007/s11259-006-3361-x|s2cid=6874332 }}

File:Removal of cyanide poison from cassava.jpg in Nigeria]]

Cyanide poisoning can result from the ingestion of cyanide salts, imbibing pure liquid prussic acid, skin absorption of prussic acid, intravenous infusion of nitroprusside for hypertensive crisis, or the inhalation of hydrogen cyanide gas. The last typically occurs through one of three mechanisms:

• The gas is directly released from canisters (e.g., as part of a pesticide, insecticide, or Zyklon B).
• It is generated on site by reacting potassium cyanide or sodium cyanide with sulfuric acid (e.g., in a modern American gas chamber).
• Fumes arise during a building fire or any similar scenario involving the burning of polyurethane,{{cite journal|last1=McKenna|first1=Sean Thomas|last2=Hull|first2=Terence Richard|title=The fire toxicity of polyurethane foams|journal=Fire Science Reviews|date=2016|volume=5|issue=1|doi=10.1186/s40038-016-0012-3|doi-access=free}} vinyl{{cite book |editor=David M. Cline |display-editors=etal |title=Tintinalli's emergency medicine manual |publisher=McGraw-Hill Medical|location=New York|isbn=978-0-07-178184-8|page=604|edition=7th|date=2012}} or other polymer products that required nitriles in their production.

As potential contributing factors, cyanide is present in:

• Tobacco smoke.
• A number of seeds or kernels such as those of almonds, apricots, apples, oranges, and flaxseed.{{cite journal |author=((EFSA Panel on Contaminants in the Food Chain)) |title=Evaluation of the health risks related to the presence of cyanogenic glycosides in foods other than raw apricot kernels |date=2019 |journal=European Food Safety Authority Journal |volume=17 |issue=4 |at=e05662 |doi=10.2903/j.efsa.2019.5662 |pmid=32626287 |pmc=7009189 |s2cid=146077876 |doi-access=free }}
• Foods including cassava (also known as tapioca, yuca or manioc) and bamboo shoots.

As a potential harm-reduction factor, vitamin B12, in the form of hydroxocobalamin (also spelled hydroxycobalamin), might reduce the negative effects of chronic exposure; whereas, a deficiency might worsen negative health effects following exposure to cyanide.{{cite journal|pmid=494304|title=Effects of low cobalamin diet and chronic cyanide toxicity in baboons | volume=12|issue=3|year=1979 |vauthors=Crampton RF, Gaunt IF, Harris R, etal |journal=Toxicology|pages=221–234|doi=10.1016/0300-483X(79)90068-4|bibcode=1979Toxgy..12..221C }}

Cyanide is a potent cytochrome c oxidase (COX, a.k.a. Complex IV) inhibitor, causing asphyxiation of cells. As such, cyanide poisoning is a form of histotoxic hypoxia, because it interferes with the ability of cells to take or use oxygen via oxidative phosphorylation.{{cite book |last1=Berg |first1=Jeremy M. |last2=Tymoczko |first2=John L. |last3=Stryer |first3=Lubert |title=Biochemistry |date=2002 |publisher=W. H. Freeman |location=New York |isbn=0-7167-3051-0 |edition=5th}}{{rp|1475}}

Specifically, cyanide binds to the heme a3-CuB binuclear center of COX{{cite journal |last1=Leavesley |first1=Heather B. |last2=Li |first2=Li |last3=Prabhakaran |first3=Krishnan |last4=Borowitz |first4=Joseph L. |last5=Isom |first5=Gary E. |title=Interaction of Cyanide and Nitric Oxide with Cytochrome c Oxidase: Implications for Acute Cyanide Toxicity |journal=Toxicological Sciences |date=January 2008 |volume=101 |issue=1 |pages=101–111 |doi=10.1093/toxsci/kfm254 |pmid=17906319 |url=https://academic.oup.com/toxsci/article/101/1/101/1657982 |access-date=9 February 2021 |doi-access=free |archive-date=5 May 2019 |archive-url=https://web.archive.org/web/20190505170041/https://academic.oup.com/toxsci/article/101/1/101/1657982 |url-status=live }} (and thus is a non-competitive inhibitor of it). This prevents electrons passing through COX from being transferred to O₂, which not only blocks the mitochondrial electron transport chain, it also interferes with the pumping of a proton out of the mitochondrial matrix which would otherwise occur at this stage. Therefore, cyanide interferes not only with aerobic respiration but also with the ATP synthesis pathway it facilitates, owing to the close relationship between those two processes.{{cite book |last1=Nelson |first1=David L. |last2=Cox |first2=Michael M. |title=Lehninger Principles of Biochemistry |date=2004 |publisher=W. H. Freeman |location=New York |isbn=978-0-7167-6265-2 |edition=4th}}{{rp|705}}

One antidote for cyanide poisoning, nitrite (i.e., via amyl nitrite), works by converting ferrohemoglobin to ferrihemoglobin, which can then compete with COX for free cyanide (as the cyanide will bind to the iron in its heme groups instead). Ferrihemoglobin cannot carry oxygen, but the amount of ferrihemoglobin that can be formed without impairing oxygen transport is much greater than the amount of COX in the body.{{rp|1475}}

Cyanide is a broad-spectrum poison because the reaction it inhibits is essential to aerobic metabolism; COX is found in multiple forms of life.{{cite journal | vauthors = Castresana J, Lübben M, Saraste M, Higgins DG | title = Evolution of cytochrome oxidase, an enzyme older than atmospheric oxygen | language = en | journal = The EMBO Journal | volume = 13 | issue = 11 | pages = 2516–2525 | date = June 1994 | pmid = 8013452 | pmc = 395125 | doi=10.1002/j.1460-2075.1994.tb06541.x}} However, susceptibility to cyanide is far from uniform across affected species; for instance, plants have an alternative electron transfer pathway available that passes electrons directly from ubiquinone to O₂, which confers cyanide resistance by bypassing COX.{{rp|704}}

Lactate is produced by anaerobic glycolysis when oxygen concentration becomes too low for the normal aerobic respiration pathway. Cyanide poisoning inhibits aerobic respiration and therefore increases anaerobic glycolysis which causes a rise of lactate in the plasma. A lactate concentration above 10 mmol per liter is an indicator of cyanide poisoning, as defined by the presence of a blood cyanide concentration above 40 μmol per liter. Lactate levels greater than 6 mmol/L after reported or strongly suspected pure cyanide poisoning, such as cyanide-containing smoke exposure, suggests significant cyanide exposure.{{cite web |last1=Leybell |first1=Inna |title=Cyanide Toxicity Workup |url=https://emedicine.medscape.com/article/814287-workup |website=Medscape |access-date=30 November 2019 |archive-date=8 November 2019 |archive-url=https://web.archive.org/web/20191108074320/https://emedicine.medscape.com/article/814287-workup |url-status=live }} However, lactate alone is not diagnostic of cyanide poisoning because lactosis is also triggered by other things, including mitochondrial dysfunction.{{cite journal | last1=Parikh | first1=Sumit | last2=Goldstein | first2=Amy | last3=Koenig | first3=Mary Kay| first17=Johan L.K. | last18=Wolfe | first18=Lynne | last19=DiMauro | first19=Salvatore | title=Diagnosis and management of mitochondrial disease: a consensus statement from the Mitochondrial Medicine Society | journal=Genetics in Medicine | publisher=Elsevier BV | volume=17 | issue=9 | year=2015 | issn=1098-3600 | doi=10.1038/gim.2014.177 | pages=689–701 | pmid=25503498 | pmc=5000852 |url=https://www.umdf.org/wp-content/uploads/2016/01/Mitochondrial-Disease-Consensus-Criteria-GIM-2015.pdf}}

Methods of detection include colorimetric assays such as the Prussian blue test, the pyridine-barbiturate assay, also known as the "Conway diffusion method"Forensic Toxicology: Principles and Concepts By Nicholas T Lappas, Courtney M Lappas, Chapter 10. and the taurine fluorescence-HPLC but like all colorimetric assays these are prone to false positives. Lipid peroxidation resulting in "TBARS", an artifact of heart attack produces dialdehydes that cross-react with the pyridine-barbiturate assay. Meanwhile, the taurine-fluorescence-HPLC assay used for cyanide detection is identical to the assay used to detect glutathione in spinal fluid.

Cyanide and thiocyanate assays have been run with mass spectrometry (LC/MS/MS), which are considered specific tests. Since cyanide has a short half-life, the main metabolite, thiocyanate is typically measured to determine exposure.

Decontamination of people exposed to hydrogen cyanide gas only requires removal of the outer clothing and the washing of their hair. Those exposed to liquids or powders generally require full decontamination.

The International Programme on Chemical Safety issued a survey (IPCS/CEC Evaluation of Antidotes Series) that lists the following antidotal agents and their effects: oxygen, sodium thiosulfate, amyl nitrite, sodium nitrite, 4-dimethylaminophenol, hydroxocobalamin, and dicobalt edetate ('Kelocyanor'), as well as several others.{{cite web |url=https://www.inchem.org/documents/antidote/antidote/ant02.htm#PartNumber:6 |title=Antidotes for Poisoning by Cyanide: 6. myl Nitrite |work=IPCS/CEC Evaluation of Antidotes Series; Volume 2 |url-status=live |archive-url=https://web.archive.org/web/20070418233830/https://www.inchem.org/documents/antidote/antidote/ant02.htm#PartNumber:6 |archive-date=18 April 2007 }} Another commonly-recommended antidote is 'solutions A and B' (a solution of ferrous sulfate in aqueous citric acid, and aqueous sodium carbonate, respectively).

The United States standard cyanide antidote kit first uses a small inhaled dose of amyl nitrite, followed by intravenous sodium nitrite, followed by intravenous sodium thiosulfate.{{EMedicine|article|814287|Toxicity, Cyanide|overview}} Hydroxocobalamin was approved for use in the US in late 2006{{cite web |title=Drug Approval Package: Cyanokit (hydroxocobalamin for injection) NDA #022041 |url=https://www.accessdata.fda.gov/drugsatfda_docs/nda/2006/022041_cyanokit_toc.cfm |access-date=2022-09-15 |website=www.accessdata.fda.gov}} and is available in Cyanokit antidote kits.{{EMedicine|article|814287|Toxicity, Cyanide|treatment}} Sulfanegen TEA, which could be delivered to the body through an intra-muscular (IM) injection, detoxifies cyanide and converts the cyanide into thiocyanate, a less toxic substance.{{cite web |url=https://news.yahoo.com/antidote-cyanide-found-132827160.html |title=New Antidote for Cyanide Found |date=February 2013 |access-date=14 January 2017 |url-status=live |archive-url=https://web.archive.org/web/20160305003617/https://news.yahoo.com/antidote-cyanide-found-132827160.html |archive-date=5 March 2016 }}{{full citation needed|date=December 2013}} Alternative methods of treating cyanide intoxication are used in other countries.

The Irish Health Service Executive (HSE) has recommended against the use of solutions A and B because of their limited shelf life, potential to cause iron poisoning, and limited applicability (effective only in cases of cyanide ingestion, whereas the main modes of poisoning are inhalation and skin contact). The HSE has also questioned the usefulness of amyl nitrite due to storage/availability problems, risk of abuse, and lack of evidence of significant benefits. It also states that the availability of kelocyanor at the workplace may mislead doctors into treating a patient for cyanide poisoning when this is an erroneous diagnosis. The HSE no longer recommends a particular cyanide antidote.{{cite web |url=https://www.hse.gov.uk/pubns/misc076.htm |title=Cyanide poisoning – New recommendations on first aid treatment |publisher=Health and Safety Executive |url-status=live |archive-url=https://web.archive.org/web/20091020204249/https://www.hse.gov.uk/pubns/misc076.htm |archive-date=20 October 2009 }}

{{reflist|group=note}}

The República Cromañón nightclub fire broke out in Buenos Aires, Argentina on 30 December 2004, killing 194 people and leaving at least 1,492 injured. Most of the victims died from inhaling poisonous gases, including carbon monoxide. After the fire, the technical institution INTI found that the level of toxicity due to the materials and volume of the building was 225 ppm of cyanide in the air. A lethal dose for rats is between 150 ppm and 220 ppm, meaning the air in the building was highly toxic.

On 27 January 2013, a fire at the Kiss nightclub in the city of Santa Maria, in the south of Brazil, caused the poisoning of hundreds of young people by cyanide released by the combustion of soundproofing foam made with polyurethane. By March 2013, 245 fatalities were confirmed.{{cite web |url=https://noticias.r7.com/cidades/autoridades-confirmam-245-pessoas-mortas-em-incendio-em-casa-noturna-de-santa-maria-rs-27012013 |language=pt |title=Número de pessoas mortas em incêndio em boate em Santa Maria, no RS, é revisado para 232 |access-date=7 August 2013 |date=27 January 2013 |archive-date=28 August 2021 |archive-url=https://web.archive.org/web/20210828052328/https://noticias.r7.com/cidades/numero-de-pessoas-mortas-em-incendio-em-boate-em-santa-maria-no-rs-e-revisado-para-232nbsp-27012013 |url-status=live }}{{cite news |last=Haynes and Prada |title=U.S. rushing treatment for Brazil fire victims |url=https://www.reuters.com/article/us-brazil-nightclub-deaths-idUSBRE9100ZF20130202 |work=Reuters |access-date=28 June 2013 |url-status=live|archive-url=https://web.archive.org/web/20130214021555/https://www.reuters.com/article/2013/02/02/us-brazil-nightclub-deaths-idUSBRE9100ZF20130202 |archive-date=14 February 2013 |date=2 February 2013 }}

{{When |reason=Largest fire in post-Soviet Russia at that time or should we count the post-Soviet years that followed? |date=May 2016}}

File:GiftgasAuschwitzMuseum.jpg canisters, found by the Soviets in January 1945 at Auschwitz]]

Research of hydrogen cyanide by chemists Carl Wilhelm Scheele and Claude Bernard would become central to understanding the lethality of future gas chambers.{{cite book | last=Christianson | first=S. | title=The Last Gasp: The Rise and Fall of the American Gas Chamber | publisher=University of California Press | year=2010 | isbn=978-0-520-25562-3 | url=https://books.google.com/books?id=AIzaoHoggUwC&pg=PA24 | access-date=2023-06-17 | page=24}} In early 1942, Zyklon B, which contains hydrogen cyanide, emerged as the preferred killing tool of Nazi Germany for use in extermination camps during the Holocaust.{{sfn|Longerich|2010|pp=281–282}} The chemical was used to murder roughly one million people in gas chambers installed in extermination camps at Auschwitz-Birkenau, Majdanek, and elsewhere.{{sfn|Hayes|2004|pp=2, 272}} Most of the people who were murdered were Jews, and by far the majority of these murders took place at Auschwitz.{{sfn|Piper|1994|p=161}}{{sfn|Hayes|2004|p=272}}{{efn|Soviet officials initially stated that over four million people were murdered using Zyklon B at Auschwitz, but this figure was later proven to be greatly exaggerated.{{cite book|url=https://www.amazon.com/Auschwitz-History-Sybille-Steinbacher-2005-01-17/dp/B017MYHO5U|last1=Steinbacher|year=2005|pages=132–133|title=Auschwitz: A History|publisher=Penguin|access-date=27 February 2021|archive-date=15 March 2022|archive-url=https://web.archive.org/web/20220315171809/https://www.amazon.com/Auschwitz-History-Sybille-Steinbacher-2005-01-17/dp/B017MYHO5U|url-status=live}} }} The constituents of Zyklon B were manufactured by several companies under licenses for Degesch, a corporation co-owned by IG Farben, Degussa and Th. Goldschmidt AG. It was sold to the German Army and the Schutzstaffel (SS) by the distributors Heli and Testa, with Heli supplying it to concentration camps at Mauthausen, Dachau, and Buchenwald and Testa to Auschwitz and Majdanek.{{cite book |last=Christianson |first=Scott |title=The last gasp: the rise and fall of the American gas chamber |date=2010 |publisher=University of California Press |isbn=978-0-520-25562-3 |location=Berkeley, Calif. |pages=166}} Camps also occasionally bought Zyklon B directly from the manufacturers.{{sfn|Hayes|2004|pp=288–289}} Of the 729 tonnes of Zyklon B sold in Germany in 1942–44, 56 tonnes (about eight percent of domestic sales) were sold to concentration camps.{{sfn|Hayes|2004|p=296}} Auschwitz received 23.8 tonnes, of which six tonnes were used for fumigation. The remainder was used in the gas chambers or lost to spoilage (the product had a stated shelf life of only three months).{{sfn|Hayes|2004|pp=294–297|loc=chpt. "[https://books.google.com/books?id=5Amej-jkAMwC&q=Zyklon+expiration Degesch and Zyklon B.]" |postscript=. "The SS learned in 1944 that the expiration dates on the Zyklon tins were not hard and fast. All in all, it seems reasonable to assume that the SS over- rather than underdosed ..." —Peter Hayes}} Testa conducted fumigations for the Wehrmacht and supplied them with Zyklon B. They also offered courses to the SS in the safe handling and use of the material for fumigation purposes.{{sfn|Hayes|2004|p=283}} In April 1941, the German agriculture and interior ministries designated the SS as an authorized applier of the chemical, and thus they were able to use it without any further training or governmental oversight.{{sfn|Hayes|2004|p=284}}

Hydrogen cyanide gas has been used for judicial execution in some states of the United States, where cyanide was generated by reaction between potassium cyanide (or sodium cyanide{{cite web |url=https://www.britannica.com/topic/gas-chamber |title=Gas chamber | execution device |access-date=3 July 2015 |url-status=live |archive-url=https://web.archive.org/web/20150628133911/https://www.britannica.com/topic/gas-chamber |archive-date=28 June 2015 }} second paragraph{{cite web |url=https://www.baltimoresun.com/1997/06/22/execution-by-gas-in-md-to-end-next-week-killer-hunts-death-will-be-last-by-method/ |title=Execution by gas in Md. To end next week Killer Hunt's death will be last by method |access-date=3 July 2015 |url-status=live |archive-url=https://web.archive.org/web/20150705032705/https://articles.baltimoresun.com/1997-06-22/news/1997173051_1_gas-chamber-hunt-lethal-injection |archive-date=5 July 2015 }}) dropped into a compartment containing sulfuric acid, directly below the chair in the gas chamber.{{cite web |url=https://civilliberty.about.com/od/capitalpunishment/ig/Types-of-Executions/Gas-Chamber-Executions.htm |title=Gas Chamber Executions |publisher=About.com |url-status=live |archive-url=https://web.archive.org/web/20090220093426/https://civilliberty.about.com/od/capitalpunishment/ig/Types-of-Executions/Gas-Chamber-Executions.htm |archive-date=20 February 2009 }}

{{For|information on methods of suicide intervention|Suicide prevention}}{{For|the pill commonly used for cyanide suicide|Suicide pill}}

Cyanide salts are sometimes used as fast-acting suicide devices. Cyanide reacts at a higher level with high stomach acidity.

• Viktor Meyer, 19th-century German chemist, died by suicide in 1897 after taking cyanide{{cite web | url=http://listverse.com/2007/10/07/top-10-scientists-who-committed-suicide/ | title=Top 10 Scientists who Committed Suicide| date=2007-10-07}}
• On 26 January 1904, company promoter and swindler Whitaker Wright died by ingesting cyanide in a court anteroom immediately after being convicted of fraud.
• Gustav Wied, Danish novelist, poet, and playwright, in 1914
• Badal Gupta, a revolutionary from Bengal, who launched an attack on the Writers' Building in Kolkata, consumed cyanide in 1930 immediately after the attack.
• In February 1937, the Uruguayan short story writer Horacio Quiroga died by drinking cyanide at a hospital in Buenos Aires.
• In 1937, polymer chemist Wallace Carothers died by drinking cyanide.
• Pritilata Waddedar, an Indian revolutionary nationalist, took cyanide in 1932 to avoid capture by Indian Imperial Police, British India
• Erwin Rommel (1944), Adolf Hitler's wife, Eva Braun (1945),{{cite book | last = Linge | first = Heinz | author-link = Heinz Linge | year = 2009 | title = With Hitler to the End | publisher = Frontline Books–Skyhorse Publishing | isbn = 978-1-60239-804-7 | language = en | url = https://archive.org/details/withhitlertoendm00ling }} and Nazi leaders Heinrich Himmler (1945), possibly Martin Bormann (1945), and Hermann Göring (1946) all died by ingesting cyanide. Pure liquid prussic acid (a historical name for hydrogen cyanide), was the favored suicide agent of Nazi Germany.
• It is speculated that, in 1954, Alan Turing used an apple that had been injected with a solution of cyanide to die after being convicted of having a homosexual relationship, which was illegal at the time in the United Kingdom, and forced to undergo hormonal castration to avoid prison. An inquest determined that Turing's death from cyanide poisoning was a suicide, although this has been disputed.
• Members of the Sri Lankan Tamil (or Eelam Tamil) LTTE (Liberation Tigers of Tamil Eelam, whose insurgency lasted from 1983 to 2009), used to wear cyanide vials around their necks with the intention of taking them if captured by the government forces.
• On 22 June 1977, Moscow, Aleksandr Dmitrievich Ogorodnik, a Soviet diplomat accused of spying on behalf of the Colombian Intelligence Agency and the US Central Intelligence Agency, was arrested. During the interrogations, Ogorodnik offered to write a full confession and asked for his pen. Inside the pen cap was a hidden cyanide pill, which when bitten on, caused Ogorodnik to die before he hit the floor, according to the Soviets.Former CIA Chief of Disguise Breaks Down Cold War Spy Gadgets | Wired
• On 18 November 1978, Jonestown. A total of 909 individuals died in Jonestown, a number of them from apparent cyanide poisoning, in an event termed "revolutionary suicide" by Jones and some members on an audio tape of the event and in prior discussions. The poisonings in Jonestown followed the murder of five others by Temple members at Port Kaituma, including United States Congressman Leo Ryan, an act that Jones ordered. Four other Temple members died by murder-suicide in Georgetown at Jones' command.
• On 6 June 1985, serial killer Leonard Lake died in custody after having ingested cyanide pills he had sewn into his clothes.
• On 28 June 2012, Wall Street trader Michael Marin ingested a cyanide pill seconds after a guilty verdict was read in his arson trial in Phoenix, Arizona; he died minutes after.{{cite news | url=https://www.cbsnews.com/news/michael-marin-former-wall-street-trader-took-cyanide-after-arson-conviction-says-autopsy/ | work=CBS News | title=Michael Marin, former Wall Street trader, took cyanide after arson conviction, says autopsy | url-status=live | archive-url=https://web.archive.org/web/20120727233413/https://www.cbsnews.com/8301-504083_162-57481400-504083/michael-marin-former-wall-street-trader-took-cyanide-after-arson-conviction-says-autopsy/ | archive-date=27 July 2012 | df=dmy-all }}
• On 22 June 2015, John B. McLemore, a horologist and the central figure of the podcast S-Town, died after ingesting cyanide.{{cite news | url=https://www.al.com/entertainment/index.ssf/2017/03/who_is_john_b_mclemore_figure.html/ | publisher=Alabama Local News | title=Who is John B. McLemore, figure in new 'S-Town' podcast? (spoilers) | url-status=dead | archive-url=https://web.archive.org/web/20170406193023/https://www.al.com/entertainment/index.ssf/2017/03/who_is_john_b_mclemore_figure.html | archive-date=6 April 2017 | df=dmy-all | access-date=1 April 2017 }}
• On 29 November 2017, Slobodan Praljak died from drinking potassium cyanide, after being convicted of war crimes by the International Criminal Tribunal for the former Yugoslavia.{{cite news|url=https://www.om.nl/@101281/preliminary-results/|title=Preliminary results autopsy Slobodan Praljak|work=Openbaar Ministerie|access-date=2017-12-01|archive-url=https://web.archive.org/web/20171203203439/https://www.om.nl/@101281/preliminary-results/|archive-date=3 December 2017|url-status=dead}}
• Ramon Sampedro, Spanish tetraplegic and activist whose assisted suicide in 1998 provoked a national debate about euthanasia, and who was the subject of the Oscar-winning film The Sea Inside
• Jason Altom, a promising graduate student in the lab of Nobel Prize–winning chemist EJ Corey at Harvard, died after drinking potassium cyanide in 1998

• In 1993, an illegal spill resulted in the death of seven people in Avellaneda, Argentina.{{cite web|date=2018-04-20|title=Recordando: "A tres años de la muerte de 7 personas por un escape de gas tóxico no hay culpables" (artículo del 28/09/1996)|url=https://redproteger.com.ar/safetyblog/recordando-a-tres-anos-de-la-muerte-de-7-personas-por-un-escape-de-gas-toxico-no-hay-culpables-articulo-del-28-09-1996/|access-date=2021-09-27|website=Safety Blog®|language=es|archive-date=27 September 2021|archive-url=https://web.archive.org/web/20210927175553/https://redproteger.com.ar/safetyblog/recordando-a-tres-anos-de-la-muerte-de-7-personas-por-un-escape-de-gas-toxico-no-hay-culpables-articulo-del-28-09-1996/|url-status=live}} In their memory, the National Environmental Conscious Day (Día Nacional de la Conciencia Ambiental) was established.{{cite web|title=InfoLeg - Información Legislativa|url=https://servicios.infoleg.gob.ar/infolegInternet/verNorma.do?id=32306|access-date=2021-09-27|website=servicios.infoleg.gob.ar|archive-date=27 September 2021|archive-url=https://web.archive.org/web/20210927183543/https://servicios.infoleg.gob.ar/infolegInternet/verNorma.do?id=32306|url-status=live}}
• In 2000, a spill at Baia Mare, Romania, resulted in the worst environmental disaster in Europe since Chernobyl.[https://news.bbc.co.uk/2/hi/europe/642880.stm "Death of a river"] {{webarchive|url=https://web.archive.org/web/20090109134649/https://news.bbc.co.uk/2/hi/europe/642880.stm |date=9 January 2009 }}, BBC, 15 February 2000
• In 2000, Allen Elias, CEO of Evergreen Resources was convicted of knowing endangerment for his role in the cyanide poisoning of employee Scott Dominguez.{{cite news|last1=Kenworthy|first1=Tom|title=A Life 'Trashed' in Cyanide Tank Long Prison Term Predicted in Environmental Crime|url=https://www.washingtonpost.com/wp-srv/WPcap/1999-12/13/011r-121399-idx.html|access-date=1 February 2015|newspaper=The Washington Post|date=13 December 1999|url-status=live|archive-url=https://web.archive.org/web/20150202013433/https://www.washingtonpost.com/wp-srv/WPcap/1999-12/13/011r-121399-idx.html|archive-date=2 February 2015}}{{cite book|last1=Dugoni|first1=Robert|last2=Hilldorfer|first2=Joseph|title=The Cyanide Canary|date=2004|publisher=Simon & Schuster|isbn=978-0-7432-4652-1|pages=[https://archive.org/details/cyanidecanary00hill/page/1 1–352]|url=https://archive.org/details/cyanidecanary00hill/page/1}} This was one of the first successful criminal prosecutions of a corporate executive by the Environmental Protection Agency.

• John Tawell, a murderer who in 1845 became the first person to be arrested as the result of telecommunications technology.
• Grigori Rasputin (1916; attempted, later killed by gunshot)
• The Goebbels children (1945)
• Stepan Bandera (1959)
• Jonestown, Guyana, was the site of a large mass murder–suicide,{{cite web|title=Was It Murder or Suicide: A Forum|url=https://jonestown.sdsu.edu/?page_id=31981|website=Alternative Considerations of Jonestown & Peoples Temple|access-date=12 June 2016|url-status=live|archive-url=https://web.archive.org/web/20160326182425/https://jonestown.sdsu.edu/?page_id=31981|archive-date=26 March 2016}} in which over 900 members of the Peoples Temple drank potassium cyanide–laced Flavor Aid in 1978.
• Chicago Tylenol murders (1982)
• Timothy Marc O'Bryan (1966–1974) died on October 31, 1974, by ingesting potassium cyanide placed into a giant Pixy Stix. His father, Ronald Clark O'Bryan, was {{cite web|title=Ronald Clark O'Bryan, Appellant, v. The State of Texas, Appellee|url=https://law.justia.com/cases/texas/court-of-criminal-appeals/1979/59731-3.html}} convicted of Tim's murder plus four counts of attempted murder. O'Bryan put potassium cyanide into five giant Pixy Stix that he gave to his son and daughter along with three other children. Only Timothy ate the poisoned candy and died.
• Bruce Nickell and Sue Snow (5 June 1986) Murdered by Stella Nickell who poisoned bottles of Excedrin.
• Richard Kuklinski (1935–2006)
• Janet Overton (1942–1988) Her husband, Richard Overton, was convicted of poisoning her,{{cite web | title=Overton Found Guilty of Wife's Cyanide Murder | website=Los Angeles Times | date=9 May 1995 | url=https://www.latimes.com/archives/la-xpm-1995-05-09-mn-64088-story.html | ref={{sfnref | Los Angeles Times | 1995}} | access-date=2019-12-27 | archive-date=27 December 2019 | archive-url=https://web.archive.org/web/20191227024205/https://www.latimes.com/archives/la-xpm-1995-05-09-mn-64088-story.html | url-status=live }} but Janet's symptoms did not match those of classic cyanide poisoning, the timeline was inconsistent with cyanide poisoning, and the amount found was just a trace. The diagnostic method used was prone to false positives. Richard Overton died in prison in 2009.
• Urooj Khan (1966–2012), won the lottery and was found dead a few days later.{{cite news | last=Gorner | first=Jeremy | title=Lottery winner's cyanide poisoning death remains unsolved five years later | work=Chicago Tribune | date=25 July 2017 | url=https://www.chicagotribune.com/news/breaking/ct-cyanide-poisoning-death-lottery-winner-met-20170725-story.html | access-date=2019-12-27 | archive-date=27 December 2019 | archive-url=https://web.archive.org/web/20191227024203/https://www.chicagotribune.com/news/breaking/ct-cyanide-poisoning-death-lottery-winner-met-20170725-story.html | url-status=live }} A blood diagnostic reported a lethal level of cyanide in his blood, but the body did not display any classic symptoms of cyanide poisoning, and no link to cyanide could be found in Urooj's social circle. The diagnostic method used was the Conway diffusion method, prone to false positives with artifacts of heart attack and kidney failure. The chemistry of this and other false positives could be linked to the TBARS response following heart failure.
• Autumn Marie Klein (20 April 2013), a prominent 41-year-old neuroscientist and physician, died from cyanide poisoning.{{cite web |last1=Reed Ward |first1=Paula |title=The Ferrante trial: A look inside the cyanide poisoning case |url=https://www.post-gazette.com/local/city/2014/10/19/The-Ferrante-trial-Inside-the-Autumn-Marie-Klein-cyanide-poisoning-case-in-Pittsburgh/stories/201410190091 |publisher=Pittsburgh Post-Gazette |access-date=29 July 2022}} Klein's husband, Robert J. Ferrante, also a prominent neuroscientist who used cyanide in his research, was convicted of murder and sentenced to life in prison for her death. Robert Ferrante is appealing his conviction, claiming the cyanide was a false positive.{{cite web |url=https://www.cbsnews.com/news/jury-pittsburgh-researcher-robert-ferrante-poisoned-his-wife-autumn-klein/ |title=Pittsburgh researcher convicted of poisoning wife with cyanide |website=CBS News |date=7 November 2014 |access-date=13 February 2017 |url-status=live |archive-url=https://web.archive.org/web/20170213170407/https://www.cbsnews.com/news/jury-pittsburgh-researcher-robert-ferrante-poisoned-his-wife-autumn-klein/ |archive-date=13 February 2017 }}
• Mirna Salihin died in hospital on 6 January 2016, after drinking a Vietnamese iced coffee at a cafe in a shopping mall in Jakarta. Police reports claim that cyanide poisoning was the most likely cause of her death.
• Jolly Thomas of Kozhikode, Kerala, India, was arrested in 2019 for the murder of 6 family members. Murders took place over a 14-year period, and each victim ate a meal prepared by the killer. The murders were allegedly motivated by wanting control of the family finances and property.{{cite news |last1=Dhillon |first1=Amrit |title=Woman in India admits poisoning six family members with cyanide |url=https://www.theguardian.com/world/2019/oct/07/woman-in-india-admits-poisoning-six-family-members-with-cyanide |access-date=8 October 2019 |work=The Guardian |date=7 October 2019 |archive-date=8 October 2019 |archive-url=https://web.archive.org/web/20191008005149/https://www.theguardian.com/world/2019/oct/07/woman-in-india-admits-poisoning-six-family-members-with-cyanide |url-status=live }}
• Mei Xiang Li of Brooklyn, New York, collapsed and died in April 2017, with cyanide later reported to be in her blood.{{cite news |last1=Parascandola |first1=Kerry Burke, Rocco |title=Sunset Park family reeling after they learn their matriarch had high levels of cyanide in her blood when she died – NY Daily News |url=https://www.nydailynews.com/new-york/brooklyn/son-reels-learns-mom-died-cyanide-poisoning-article-1.3075881 |access-date=11 July 2018 |work=nydailynews.com |archive-date=10 July 2018 |archive-url=https://web.archive.org/web/20180710163753/https://www.nydailynews.com/new-york/brooklyn/son-reels-learns-mom-died-cyanide-poisoning-article-1.3075881 |url-status=live }} However, Mei never exhibited symptoms of cyanide poisoning and no link to cyanide could be found in her life.
• Sararath "Am" Rangsiwutthiporn, who became quickly known as "Am Cyanide" in Thai media, was arrested by the Thai police for allegedly poisoning 11 of her friends and acquaintances, spanning 2020 to 2023, with 10 deaths and 1 surviving supposed victim.{{cite news | last1=Rebecca Ratcliffe | title=Thai police investigate 10 deaths as woman accused of poisoning friend |first1=Navaon Siradapuvadol | url=https://www.theguardian.com/world/2023/apr/25/thai-police-investigate-other-deaths-as-woman-accused-of-poisoning-friend }} According to an ongoing investigation, the number of victims is currently at 20-30 persons, mostly dead with several survived.

• In 1988, between 3,200 and 5,000 people died in the Halabja massacre owing to unknown chemical nerve agents. Hydrogen cyanide gas was strongly suspected.{{cite web|url=https://emergency.cdc.gov/agent/cyanide/basics/facts.asp|date=April 4, 2018|author=Centers for Disease Control and Prevention|title=Facts About Cyanide}}Eric Croddy with Clarisa Perez-Armendariz & John Hart, Chemical and Biological Warfare: A Comprehensive Survey for the Concerned Citizen (Spring Science+Business Media, 2002), p. 164.
• In 1995, a device was discovered in a restroom in the Kayabachō Tokyo subway station, consisting of bags of sodium cyanide and sulfuric acid with a remote controlled motor to rupture them, in what was believed to be an attempt by the Aum Shinrikyo cult to produce toxic amounts of hydrogen cyanide gas.{{cite web | title = Chronology of Aum Shinrikyo's CBW Activities | url = https://cns.miis.edu/reports/pdfs/aum_chrn.pdf | publisher = Monterey Institute of International Studies | year = 2001 | url-status = dead | archive-url = https://web.archive.org/web/20111126070839/https://cns.miis.edu/reports/pdfs/aum_chrn.pdf | archive-date = 26 November 2011 }}
• In 2003, Al Qaeda reportedly planned to release cyanide gas into the New York City Subway system. The attack was supposedly aborted because there would not be enough casualties.{{cite magazine |url=https://www.time.com/time/magazine/article/0,9171,1205478,00.html |title=The Untold Story of al-Qaeda's Plot to Attack the Subway |magazine=Time magazine |date=19 June 2006 |access-date=20 January 2007 |first=Ron |last=Suskind |url-status=dead |archive-url=https://web.archive.org/web/20070110115856/https://www.time.com/time/magazine/article/0,9171,1205478,00.html |archive-date=10 January 2007 }}

Cobinamide is the final compound in the biosynthesis of cobalamin. It has greater affinity for the cyanide than cobalamin itself, which suggests that it could be a better option for emergency treatment.{{cite book |last1=Suman |first1=Sigridur G. |title=Essential Metals in Medicine: Therapeutic Use and Toxicity of Metal Ions in the Clinic |last2=Gretarsdottir |first2=Johanna M. |last3=Sigel |first3=Astrid |last4=Freisinger |first4=Eva |last5=Sigel |first5=Roland K. O. |last6=Carver |first6=Peggy L. |date=2019 |publisher=de Gruyter |isbn=978-3-11-052691-2 |location=Berlin |pages=359–391 |chapter=Chapter 14. Chemical and Clinical Aspects of Metal-Containing Antidotes for Poisoning by Cyanide |series=Metal Ions in Life Sciences, vol. 19 |volume=19 |doi=10.1515/9783110527872-020 |pmid=30855115 |s2cid=73728106}}

• Amygdalin
• Anaerobic glycolysis
• Lactic acidosis
• List of poisonings
• Konzo
• Murburn concept

{{notelist}}

{{Reflist}}

• {{cite book | last = Longerich | first = Peter | author-link = Peter Longerich | title = Holocaust: The Nazi Persecution and Murder of the Jews | year = 2010 | isbn = 978-0-19-280436-5 | publisher = Oxford University Press | location = Oxford; New York }}
• {{cite book | last = Hayes | first = Peter | author-link=Peter Hayes (historian) |title = From Cooperation to Complicity: Degussa in the Third Reich | year = 2004 | publisher = Cambridge University Press | location = Cambridge; New York; Melbourne | isbn = 978-0-521-78227-2 }}
• {{cite book | last = Piper | first = Franciszek | editor1-last = Gutman | editor1-first = Yisrael | editor1-link = Yisrael Gutman | editor2-last = Berenbaum | editor2-first = Michael | title = Anatomy of the Auschwitz Death Camp | chapter = Gas Chambers and Crematoria | pages = [https://archive.org/details/anatomyofauschwi00yisr/page/157 157–182] | year = 1994 | publisher = Indiana University Press | location = Bloomington| isbn = 978-0-253-32684-3 | chapter-url = https://archive.org/details/anatomyofauschwi00yisr | url-access = registration | url = https://archive.org/details/anatomyofauschwi00yisr/page/157 }}

{{Medical resources

| DiseasesDB = 3280

| ICD10 = {{ICD10|T|65|0|t|51}}

| ICD9 = {{ICD9|989.0}}

| ICDO =

| OMIM =

| MedlinePlus =

| eMedicineSubj = med

| eMedicineTopic = 487

| MeshID =

}}

{{Poisoning and toxicity}}

{{DEFAULTSORT:Cyanide Poisoning}}

Category:Cyanides

Category:Neurotoxins

Category:Wikipedia medicine articles ready to translate

Category:Wikipedia emergency medicine articles ready to translate

Category:Toxic effects of substances chiefly nonmedicinal as to source