Cyanide is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

Cyanide is one of the most rapidly acting and lethal poisons in existence. Cyanide has an odor of bitter almonds; however, only 50% of the population can detect it.1


  • Inhalation of smoke from structural fires is the most common source of cyanide exposure in the United States and Western countries.
  • Other etiologies include artificial nail remover, older rodenticides, electroplating solutions, photographic developer solutions, laboratory reagents, laetrile, plants (e.g., pits from the Prunus species if chewed), food such as cassava, and metabolism of sodium nitroprusside.


  • Cyanide is a chemical asphyxiant. It induces cellular hypoxia by inhibiting complex IV (also known as cytochrome c oxidase or cytochrome oxidase aa3) in the electron transport chain and thus preventing the formation of adenosine triphosphate.
  • Hyperlactemia occurs from inhibition of aerobic metabolism.

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