Cyanogen Chloride Poisoning Clinical Presentation

  • Author: Heather Murphy-Lavoie, MD, FAAEM; Chief Editor: Robert G Darling, MD, FACEP   more...
 
Updated: Nov 17, 2011
 

History and Physical Examination

When taking a history from a patient with possible toxic gas exposure, ask about the smell and color of the gas, onset of symptoms, duration and severity of symptoms, and effect on surroundings (eg, dead animals, other people). Cyanogen chloride (CK) is a colorless liquid or gas with a pungent biting odor, which may in fact go unnoticed because of discomfort.

Dosing and symptoms

In low doses, symptoms that may be associated with cyanogen chloride (CK) exposure include the following:

  • Bronchorrhea
  • Lacrimation
  • Rhinorrhea

In moderate range doses, symptoms that may be associated with cyanogen chloride (CK) exposure include the following:

  • Onset possibly takes several minutes, except for immediate irritant effects
  • Transient hyperpnea
  • Feelings of anxiety or apprehension
  • Vertigo
  • Nausea and/or vomiting
  • Prolonged prodrome before loss of consciousness
  • Seizures
  • Bradypnea followed by apnea
  • Cardiac arrest

In high doses, symptoms that may be associated with cyanogen chloride (CK) exposure include the following:

  • Transient hyperpnea
  • Seizures 15-30 seconds later
  • Apnea 2-3 minutes later
  • Cardiac arrest 6-8 minutes postexposure

Physical signs

Although patients may suffer from any of the above symptoms, physical findings are generally nonspecific and similar to those of severe hypoxemia. Severe prolonged exposure culminates in respiratory distress, convulsions, and apnea.

Patients may have cherry red or pink skin because of concomitant carbon monoxide poisoning or because of cyanide-induced lack of oxygen extraction at the tissue level and vasodilation. Arterialization of the venous blood may also be noted at phlebotomy or upon examination of the retinal veins. However, note that bright red skin or absence of cyanosis is rarely described. Cyanosis may be observed and most likely stems from concomitant cardiovascular collapse, seizures, or apnea. Finally, many cyanide victims have normal-appearing skin.

Patients are initially hypertensive, tachypneic, and bradycardic, but eventually they become hypotensive. They may experience a transient tachycardia before spiraling into bradydysrhythmia that deteriorates into asystole.

Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Heather Murphy-Lavoie, MD, FAAEM  Assistant Professor, Assistant Residency Director, Emergency Medicine Residency, Associate Program Director, Hyperbaric Medicine Fellowship, Section of Emergency Medicine and Hyperbaric Medicine, Louisiana State University School of Medicine in New Orleans; Clinical Instructor, Department of Surgery, Tulane University School of Medicine

Heather Murphy-Lavoie, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine, and Undersea and Hyperbaric Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Jorge A Martinez, MD, JD  Clinical Professor, Department of Internal Medicine, Louisiana State University School of Medicine in New Orleans; Clinical Instructor, Department of Surgery, Tulane School of Medicine

Jorge A Martinez, MD, JD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Cardiology, American College of Emergency Physicians, American College of Physicians, and Louisiana State Medical Society

Disclosure: Nothing to disclose.

Andre Pennardt, MD, FACEP, FAAEM, FAWM  Clinical Associate Professor of Emergency Medicine, Medical College of Georgia; Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences; Consulting Staff, Departments of Emergency Medicine, Aviation Medicine and Dive Medicine, Womack Army Medical Center

Andre Pennardt, MD, FACEP, FAAEM, FAWM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Association of Military Surgeons of the US, International Society for Mountain Medicine, National Association of EMS Physicians, Special Operations Medical Association, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Robert G Darling, MD, FACEP  Adjunct Clinical Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; Associate Director, Center for Disaster and Humanitarian Assistance Medicine

Robert G Darling, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Telemedicine Association, and Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

Additional Contributors

Rick Kulkarni, MD Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Suzanne White, MD Medical Director, Regional Poison Control Center at Children's Hospital, Program Director of Medical Toxicology, Associate Professor, Departments of Emergency Medicine and Pediatrics, Wayne State University School of Medicine

Suzanne White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Clinical Toxicology, American College of Epidemiology, American College of Medical Toxicology, American Medical Association, and Michigan State Medical Society

Disclosure: Nothing to disclose.

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