Phenylacetonitrile in locusts facilitates an antipredator defense by acting as an olfactory aposematic signal and cyanide precursor

Many aggregating animals use aposematic signals to advertise their toxicity to predators. However, the coordination between aposematic signals and toxins is poorly understood. Here, we reveal that phenylacetonitrile (PAN) acts as an olfactory aposematic signal and precursor of hypertoxic hydrogen cyanide (HCN) to protect gregarious locusts from predation. We found that PAN biosynthesis from phenylalanine is catalyzed by CYP305M2, a novel gene encoding a cytochrome P450 enzyme in gregarious locusts. The RNA interference (RNAi) knockdown of CYP305M2 increases the vulnerability of gregarious locusts to bird predation. By contrast, the elevation of PAN levels through supplementation with synthetic PAN increases the resistance of solitary locusts to predation. When locusts are attacked by birds, PAN is converted to HCN, which causes food poisoning in birds. Our results indicate that locusts develop a defense mechanism wherein an aposematic compound is converted to hypertoxic cyanide in resistance to predation by natural enemies.

Drying and processing protocols affect the quantification of cyanogenic glucosides in forage sorghum

BACKGROUND

Cyanogenic glucosides are common bioactive products that break down to release toxic hydrogen cyanide (HCN) when combined with specific β-glucosidases. In forage sorghum, high concentrations of the cyanogenic glucoside dhurrin lead to reduced productivity and sometimes death of grazing animals, especially in times of drought, when the dhurrin content of stunted crops is often higher. The aim of this study was to develop harvesting protocols suitable for sampling in remote areas.

RESULTS

Dhurrin concentration in air- and oven-dried leaves was the same as in fresh leaves, with no subsequent losses during storage. Dhurrin concentration was halved when leaves were freeze-dried, although activity of the endogenous dhurrinase was preserved. Direct measurement of dhurrin concentration in methanolic extracts using liquid chromatography/mass spectrometry (LC/MS) gave similar results to methods that captured evolved cyanide. A single freezing event was as effective as fine grinding in facilitating complete conversion of dhurrin to cyanide.

CONCLUSION

Direct measurement of dhurrin using LC/MS is accurate but expensive and not appropriate for fieldwork. Air drying provides an accurate, low-cost method for preparing tissue for dhurrin analysis, so long as the specific β-glucosidase is added. It is recommended that comparative studies like the one presented here be extended to other cyanogenic species.

[Assessment of exposure to hydrogen cyanide in fire fatalities in the aspects of endogenous hydrogen cyanide production as a result of putrefaction processes in the deceased]

On account of endogenous hydrogen cyanide (HCN) production in the deceased, it is not easy to assess exposure to HCN in people who died in fire involving closed rooms (flats, garages, cellars, etc). In the paper, the authors present the results of blood determinations of hydrogen cyanide in fatalities of explosions and fires occurring in coal-mines, as well as fires in closed rooms. It has been demonstrated that the time of exposure to a high temperature and the temperature itself hamper autolysis processes that lead to production of endogenous HCN in fire fatalities.

[Acute encephalopathy caused by cyanogenic fungi in 2004, and magic mushroom regulation in Japan]

Two topics, related to mushroom poisoning of recent interest in Japan, have been presented. In autumn 2004, 59 cases of acute encephalopathy were reported across 9 prefectures in Japan (24 from Akita Prefecture with 8 deaths; age 48-93, average 70; female 14, male 10). Of 24 cases, 20 had kidney dysfunction. Four poisoned subjects showed no kidney trouble. Of the 24 poisoning cases, 23 people ate Pleurocybella porrigens, and one ate Grifola frondosa. The latter subject (female, late 40's) was receiving dialysis for more than 35 years. In August, she felt dizziness, headache and tinnitus. She visited hospital and asked to stay there. In the hospital she ate 5g of stewed G. frondosa and 10g of the same fungus boiled with chicken and taro on different days. Fourteen to 18 days after the eatings, she developed cramps and lost consciousness, and fell into a coma. Her cramp and coma continued for about 10 days almost until her death. Her symptoms caused by G. frondosa were similar to those observed for the above 23 cases of P. porrigens ingestion. Therefore, we concluded that encephalopathy experienced in Akita Prefecture caused by was the cyanogenic fungi such as P. porrigens , G. frondosa, Pleurotus eringii etc. Although the amounts of mushrooms eaten by poisoned subjects were not so clear, we estimated that the amounts of hydrogen cyanide (HCN) taken into human bodies exceeded the detoxication limit of HCN, resulting in HCN poisoning. However, it has not been proved that the encephalopathy is directly or indirectly caused by the HCN poisoning. Many typhoons came across Japan and landed 10 times in 2004, and mushroom size was larger than usual one, and HCN contents in fruit-bodies seemed to be increased especially in the late-stage of their growth. Thirteen species of magic mushrooms were prohibited by the law from 2002 in Japan. They include Copelandia (Panaeolus) cyanescens, Panaeolus papilionaceus, Panaeolus sphinctrinus, Panaeolus subbalteatus, Psilocybe argentipes, Psilocybe cubensis, Psilocybe fasciata, Psilocybe lonchophorus, Psilocybe subaeruginascens, Psilocybe subcaerulipes, Psilocybe subcubensis, Psilocybe tampanensis, and Psilocybe venenata.

[The effect of high temperature on the levels of selected endogenous compounds]

The authors present their research on the levels of carboxyhemoglobin, hydrogen cyanide and ethyl alcohol in the blood of 23 fatalities found in the extreme conditions (methane explosion, fire, high temperature) associated with a mining disaster. Determinations of the presence of carboxyhemoglobin, hydrogen cyanide, and ethyl alcohol were performed as soon as the blood samples were collected from the deceased. The concentration of ethyl alcohol ranged from 0.2 per thousand to 1.3 per thousand in 18 cases. Blood HbCO levels tested within the range of 11% to 83% in 17 cases. In six cases, HbCO tested negative, and the injuries found at autopsy indicated these individuals to have been killed at the moment of the explosion. Blood cyanide content tested negative in all the examined cases. The extreme conditions of the mining disaster, especially high temperature, to which the bodies were exposed, did not have any effect either on endogenous cyanide or carboxyhemoglobin, causing, however, a significant increase in the level of ethyl alcohol in the blood.

Report of the investigation committee into the cyanide poisonings of Providence firefighters

In the afternoon of March 23, 2006 a Providence firefighter was diagnosed as having cyanide poisoning after working at a building fire. In the aftermath of three fires at commercial and residential sites that day, eight additional firefighters (out of 28 tested) were found to have elevated levels of cyanide. Numerous other members reported symptoms consistent with cyanide poisoning, including headaches, weakness and fatigue, nausea, and shortness of breath. The Providence Fire Department (PFD) established a joint union management committee to review the situation.

Prospective Study of Hydroxocobalamin for Acute Cyanide Poisoning in Smoke Inhalation

STUDY OBJECTIVE

To assess outcomes in patients treated with hydroxocobalamin at the fire scene or in the ICU for suspected smoke inhalation-associated cyanide poisoning.

METHODS

Adult smoke inhalation victims with suspected cyanide poisoning as determined by soot in the face, mouth, or nose or expectorations and neurologic impairment received an intravenous infusion of hydroxocobalamin 5 g (maximum 15 g) at the fire scene or in the ICU in this observational case series conducted from 1987 to 1994. Blood cyanide specimens were collected before administration of hydroxocobalamin. The threshold for cyanide toxicity was predefined as greater than or equal to 39 micromol/L.

RESULTS

The sample included 69 patients (mean age 49.6 years; 33 men), of whom 39 were comatose. Out-of-hospital deaths were excluded. Fifty of the 69 patients (72%) admitted to the ICU survived after administration of hydroxocobalamin. In the group in which cyanide poisoning was confirmed a posteriori (n=42), 67% (28/42) survived after administration of hydroxocobalamin. The most common adverse events were chromaturia (n=6), pink or red skin discoloration (n=4), hypertension (n=3), erythema (n=2), and increased blood pressure (n=2). No serious adverse events were attributed to hydroxocobalamin. Laboratory tests revealed transient alterations in renal and hepatic function consistent with the critical condition of the patients and mild anemia consistent with progressive hemodilution.

CONCLUSION

Empiric administration of hydroxocobalamin was associated with survival among 67% of patients confirmed a posteriori to have had cyanide poisoning. Hydroxocobalamin was well tolerated irrespective of the presence of cyanide poisoning. Hydroxocobalamin appears to be safe for the out-of-hospital treatment of presumptive cyanide poisoning from smoke inhalation.

Potential Interference by Hydroxocobalamin on Cooximetry Hemoglobin Measurements During Cyanide and Smoke Inhalation Treatments

STUDY OBJECTIVE

Concentrated aqueous solutions of hydroxocobalamin (OHCob) are administered intravenously for cyanide poisoning victims, many of whom also have concurrent smoke inhalation. Because of its intense light absorbance in visible wavelengths (absorption peak at 532 nm), we investigate potential interference effects of OHCob on total hemoglobin concentration (tHb), carboxyhemoglobin (COHb), methemoglobin (MetHb), and oxyhemoglobin (Hb-O2) cooximetry measurement values in blood.

METHODS

In vivo cooximetry measurements were conducted with 3 specific pathogen-free white New Zealand rabbits (3.80+/-0.21 kg) during the intravenous infusion of OHCob (625 mg during a 100-minute period). Resultant changes in tHb, Hb-O2, COHb, and MetHb values were measured and correlated with respect to estimated in vivo OHCob concentrations. In vitro measurements were conducted with rabbit blood to confirm in vivo measurements.

RESULTS

The introduction of OHCob clearly interfered with the cooximetry measurements of each of the hemoglobin component fractions in whole blood and resulted in altered measurement values from the baseline values. The presence of OHCob in blood interferes with cooximetry measurements of COHb, MetHb, and Hb-O2. The increase in measured COHb fraction with increasing concentrations of OHCob was most notable.

CONCLUSION

The presence of OHCob in blood interferes with cooximetry measurements of COHb, MetHb, and Hb-O2. These effects need to be considered during OHCob treatment of cyanide poisoning, particularly in smoke inhalation victims with potential for concurrent carbon monoxide exposure, because it may lead to potentially erroneous reported COHb levels.

[Opinionating on the cause of poisoning and death in fire victims]

In the years 1995-2005, 273 cases of fatalities resulting from a fire were investigated in the Chair of Forensic Medicine, Medical University of Silesia, Katowice. To explain the circumstances and determine the cause of death, in each case, autopsies, as well as toxicological determinations of toxic gases, such as carbon monoxide or hydrogen cyanide, were carried out. Alcohol intoxication status of the victims was also determined. Based on the obtained results, comprehensive toxicological and medico-legal opinions on the cause of death of all the examined fire-associated fatalities were done.

Chronic poisoning by hydrogen cyanide in cassava and its prevention in Africa and Latin America

Africa produces more than 30 million tons of cassava on about 5 million hectares (6 tons per hectare). Approximately 80% of the root production and 70% of the harvested area are from Western Africa. Recent reports suggest that the ingestion of poorly processed cassava roots is associated with the incidence of an ataxic neuropathy (konzo) in African countries. When cassava-based diets are not supplemented with good sources of protein and iodine, goiter and rickets are also prevalent. In certain countries of Africa where the rate of ataxic neuropathy is high, the incidence of thyroid disorders is also high. Persons consuming poorly processed cassava in large quantities are susceptible to neuropathologies caused by cyanide. Cyanide detoxification in the body is impaired by protein deficiency. When properly processed, the root of cassava is safe and cheap as a major dietary energy source for humans and domestic animals; however, a cassava-based diet will lack sufficient protein and will be particularly deficient for the growth and development of children unless it is supplemented by protein from animal, including fish, or legume sources. Cassava leaves, if they are appropriately cooked, can be a useful source of some nutrients.

[The role of ethanol in complex poisonings with carbon monoxide and hydrogen cyanide in fire victims]

A total of 230 cases of deaths in burning spaces dating from the years 1995-2003 were investigated in Forensic Medicine Department, Silesian University of Medicine, Katowice. HbCO and HCN found in 177 blood samples ranged from 4-95 % (mean, 31,5 %) and 0,5-40,3 microg/ml (mean, 9,98 microg/ml), respectively. Moreover, ethanol was found in 122 blood samples. Its concentration ranged from 0,89-5,0 per thousand (mean, 1,45 per thousand). A comparative analysis of HbCO and HCN levels in the groups with and without ethanol showed that the range and the mean concentration of both these xenobiotics were higher in the group with no alcohol. It was also shown that the increased ethanol caused a drop in HbCO and HCN levels. To evaluate HbCO and HCN levels, the regression and correlation analysis was used.

Severe cyanide toxicity from ???vitamin supplements???

The use of alternative medicines is increasing and poorly regulated. We describe a case of severe cyanide poisoning arising from amygdalin, a putative vitamin supplement. A 32-year-old woman arrived in the emergency department by ambulance unresponsive, shocked and with fixed dilated pupils. She was hypothermic and tachycardic but was breathing spontaneously. Despite her age, she had documented breast cancer with hepatic metastases. Conventional treatment having failed, she only took 'vitamin supplements' bought on the Internet, her father said. Over the next 6 h she required mechanical ventilation and increasing doses of inotropes. Diabetes insipidus developed. As the appropriateness of further treatment was considered, a relative arrived with her medications including 'vitamin B 17' or amygdalin. An Internet search identified this as a debunked cancer remedy and cyanogen. Serum thiocyanate level was markedly elevated. She recovered fully over 8 h. While various antidotes to cyanide exist, in this case supportive therapy alone proved effective.

[Levels of carbon monoxide and hydrogen cyanide in blood of fire victims in the autopsy material of the Department of Forensic Medicine, Medical University of Białystok]

The authors present the results of toxicological examination of blood of fatal victims of fires in "closed" spaces. Hydrogen cyanide was present in 26 out of 64 postmortem blood samples. COHb was found in 52 cases. The hydrogen cyanide levels ranged from 0.8 to 39.2 microg/l, the COHb levels ranged from 16.0 to 85.0%. The level of hydrogen cyanide was determined by the pyrazolopyridine method modified by Nedoma, and the COHb level was determined by the Wolff method.

Effect of combined exposure to carbon monoxide and cyanides in selected forensic cases

Carbon monoxide is a toxic gas with potentially lethal action, which forms as a result of incomplete combustion in conditions where there is a lack of oxygen and which, therefore, is present in varying percentages in environments where fire develops. In addition to carbon monoxide, other factors such as cyanide may contribute or might actually be the primary cause of a subject's demise. In cases of exposure to both substances, the role of cyanide as a toxic/lethal agent in death by asphyxiation is still not clear: some authors attribute a primary action to such a gas in causing the demise, others consider carbon monoxide to be the only cause of the lethal event. For this reason it is in the interest of forensic medicine to study all lethal cases of exposure to toxic substances originating from fires of various types of materials, in order to determine information regarding kinetic action and the possible strengthening of the effect of the two substances. Two case studies are presented here, in which the results of the toxicological examinations are quite different, and the contributions of CO and HCN in a fire asphyxiation are considered.

Nicotine, CO and HCN: the detrimental effects of smoking on wound healing

During the 1960s, the Royal College of Physicians published its first report on smoking and health, concentrating on the association between smoking and long cancer, chronic obstructive pulmonary disease and heart disease (RCP, 2000). It was not until a decade later that the effects of smoking on wound healing were first reported (Mosely and Finseth, 1977). Although it is now widely accepted that smoking impairs wound healing, extensive studies have yet to be performed. Clinical practitioners have a role to deliver evidence-based care and provide smoking cessation programmes for patients with wounds. This article discusses three key toxins in cigarette smoke and research studies that have examined the effect of smoking on healing of acute wounds.

[Attempt to estimate risks of fatal poisoning on the basis of HCN and HbCO concentrations in blood of fire victims]

Using the results of HCN and HbCO concentrations in the blood of 174 deceased found in different burning spaces and 35 people with symptoms of poisoning evacuated from the scene of a fire and then admitted to hospital. The correlation between blood concentration of both these xenobiotics and death or chance of survival in a fire was estimated by statistical analysis. An attempt was made to define a value of so-called "cut-off" points for HbCO and HCN by independence test chi 2 with Yates's correction. Point and interval estimations (95% Comfield's confidence interval) were used for the odds ratio (OR). The research showed that there was a strict statistical correlation between the chance of survival and death risks dependent on blood concentrations of HCN and HbCO in all the groups examined.

Toxicity of fire smoke

This review is an attempt to present and describe the major immediate toxic threats in fire situations. These are carbon monoxide, a multitude of irritating organic chemicals in the smoke, oxygen depletion, and heat. During the past 50 years, synthetic polymers have been introduced in buildings in very large quantities. Many contain nitrogen or halogens, resulting in the release of hydrogen cyanide and inorganic acids in fire smoke as additional toxic threats. An analysis of toxicological findings in fire and nonfire deaths and the results of animal exposures to smoke from a variety of burning materials indicate that carbon monoxide is still likely to be the major toxicant in modern fires. However, the additional toxic threats mentioned above can sometimes be the principal cause of death or their addition can result in much lower than expected carboxyhemoglobin levels in fire victims. This analysis also revealed that hydrogen cyanide is likely to be present in appreciable amounts in the blood of fire victims in modern fires. The mechanisms of action of acute carbon monoxide and hydrogen cyanide poisonings are reviewed, with cases presented to illustrate how each chemical can be a major contributor or how they may interact. Also, lethal levels of carboxyhemoglobin and cyanide in blood are suggested from an analysis of the results of a large number of fire victims from different fire scenarios. The contribution of oxygen depletion and heat stress are more difficult to establish. From the analysis of several fire scenarios, they may play a major role in the room of origin at the beginning of a fire. The results in animal studies indicate that when major oxygen depletion (<10%) is added to lethal or sublethal levels of carbon monoxide or hydrogen cyanide its major role is to substantially reduce the time to death. In these experiments the carboxyhemoglobin level at death was slightly reduced from the expected level with exposure to carbon monoxide alone. However, blood cyanide was reduced by a factor of ten from the expected level with exposure to hydrogen cyanide alone. This is another factor (among many other presented) complicating the task of establishing the contribution of cyanide in the death of fire victims, from its analysis in their blood. Finally the role of ethanol intoxication, as it may influence carboxyhemoglobin levels at death, is reviewed. Its role is minor, if any, but the data available on ethanol in brain tissue and blood of fire victims confirmed that brain ethanol level is an excellent predictor of blood ethanol.

The clinicopathologic significance of enriching grated cassava mash with red palm oil in the production of gari

The neglect of traditional processing methods in the production of gari (toasted cassava granules) has been blamed for reported cases of poisoning following consumption of gari. This study investigated the nutritional and clinicopathologic effects of not enriching cassava mash with red palm oil (RPO) during gari production. Two gari samples were produced with and without RPO. Total cyanogen, acetone cyanohydrin, free cyanogen, and crude protein contents were not found to be significantly (p > 0.05) different between the two. The samples were fed exclusively to two different groups of Sprague-Dawley rats for a ten week experimental period during which clinical observations were recorded daily. At the end, vital body organs were examined grossly and microscopically. There was a significant (p < 0.05) reduction in severity and percentage of animals exhibiting clinical abnormalities and lesions of chronic cyanide poisoning in the group fed gari produced with RPO. This result implies an association between the enrichment of cassava mash with RPO during gari production and the reduction of severity and percentage of animals affected by chronic cyanide poisoning.

Hydrogen cyanide and carbon monoxide in blood of convicted dead in a polyurethane combustion: a proposition for the data analysis

Carbon monoxide is a well-known toxic component in fire atmospheres. However, the importance of hydrogen cyanide as a toxic agent in fire causalities is under discussion. A tragic polyurethane mattress fire provoked death of 35 convicts in a prison (Unit I, Olmos, Penitenciary Service of Buenos Aires Province, Argentina), in 1990. There is no report of any investigation carried out with such a large amount of victims in Argentina. Carboxihemoglobin (COHb) and hydrogen cyanide (HCN) were quantified in victims blood to elucidate the cause of the death. Saturation of COHb ranged between 4 and 18%, and HCN 2.0-7.2mg/l. These latter values were higher than the lethal levels reported in literature. Other toxic components routinely measured (ethanol, methanol, aldehydes and other volatile compounds) gave negative results on the 35 cases. Neither drugs of abuse nor psychotropics were detected. Statistical chi(2) analysis was applied to find differences between HCN and COHb concentrations. Saturation of COHb and HCN in blood were not independent variables (chi(2)=8.25). Moreover, the ratio COHb/HCN was constant (0.47+/-0.04). In order to evaluate the contribution of each toxic to the diagnosis, a lethal index was defined for each toxic (LI(CO) and LI(HCN)). The most probable cause of death could be inferred by a suitable plot of both indexes. The results indicated that death in the 35 fire victims was probably caused by HCN, generated during the extensive polyurethane decomposition provoked by a rapid increase of temperature.

A new spectrophotometric method for the toxicological diagnosis of cyanide poisoning

A spectrophotometric method for the determination of hydrogen cyanide in biological fluids based on the release of cyanide ion by the addition of a strong acid and its subsequent specific reaction with hydroxocobalamin to give cyanocobalamin is proposed. The release of cyanide ion is accelerated by aeration with a stream of an inert gas (nitrogen) that carries it into the hydroxocobalamin solution. Although the in vitro reaction develops to completion within 20 min, reproducible quantitation in biological media takes 45 min. The cyanocobalamin formed is quantitated by second-derivative visible spectrophotometry from the absorbance difference between 333 and 361 nm, the measured signal being proportional to the cyanide ion concentration in the sample.

An incident of hydrogen cyanide poisoning

Seven cases of hydrogen cyanide gas poisoning which occurred in an industrial building in Hong Kong are presented here. Two of them were more severely injured and required specific antidotal treatment. The other five were mild and responded to supportive treatment alone. All except one patient recovered completely. Cyanide poisoning is relatively uncommon in urbanized area, so high index of suspicion is important for early diagnosis and treatment. We believe that prevention of cyanide poisoning can be achieved by proper storage of chemicals, and by enforcing rescuers to wear special chemical protective clothing to avoid systemic poisoning because of dermal absorption of hydrogen cyanide gas. As there are newer and safer cyanide antidotes available, each emergency department should have a stock of updated products such as hydroxocobalamin.

Acute cyanide toxicity caused by apricot kernel ingestion

A 41-year-old woman ingested apricot kernels purchased at a health food store and became weak and dyspneic within 20 minutes. The patient was comatose and hypothermic on presentation but responded promptly to antidotal therapy for cyanide poisoning. She was later treated with a continuous thiosulfate infusion for persistent metabolic acidosis. This is the first reported case of cyanide toxicity from apricot kernel ingestion in the United States since 1979.

Konzo associated with war in Mozambique

We report an epidemic of konzo, symmetric spastic paraparesis associated with cassava consumption and cyanide exposure: 384 patients were treated in rehabilitation centres; the prevalence rate in a badly affected area was 30/1000. Most patients were children over 3 and women. Owing to war, communities turned to bitter cassava as their staple and took shortcuts in its processing. When the war ended, they continued to depend on inadequately processed bitter cassava. The epidemic lasted 2 years (the last year of war and the first of peace) with peaks each year during the cassava harvest. Although most cases were reported from rural inland areas, patients also came from small towns and the coast. School children had raised urinary thiocyanate and linamarin and low inorganic sulphate concentrations. Urinary thiocyanate values were lower than those previously reported in konzo epidemics, probably because we collected specimens before the cassava harvest and epidemic peak. The necessary conditions for konzo were present: intensive cultivation of bitter casava, insufficient processing, a probable high cyanide intake, and a low intake of protein-rich foods.

Combined carbon monoxide and cyanide poisoning: a place for treatment

During fires, victims can inhale significant carbon monoxide (CO) and cyanide (CN) gases, which may cause synergistic toxicity in humans. Oxygen therapy is the specific treatment for CO poisoning, but the treatment of CN toxicity is controversial. To examine the indication for treatment of CN toxicity, we have established a canine model to delineate the natural history of combined CO and CN poisoning. In seven dogs (24 +/- 3 kg), CO gas (201 +/- 43 mL) was administered by closed-circuit inhalation. Then, potassium CN was intravenously (i.v.) infused (0.072 mg.kg-1.min-1) for 17.5 +/- 3.0 min. Cardiorespiratory measurements were conducted before and after these toxic challenges. Despite significant CO poisoning (peak carboxyhemoglobin fractions [COHb] = 46% of total hemoglobin [Hb]; elimination t1/2 = 114 +/- 42 min) with attendant decrease in blood O2 content, CO had essentially little effect on any hemodynamic or metabolic variable. On the other hand, CN severely depressed most hemodynamic and metabolic functions. Compared to baseline values, CN caused significant (P < 0.01) decreases in cardiac output (6.4 +/- 2.0 to 3.1 +/- 0.5 L/min) and heart rate (169 +/- 44 to 115 +/- 29 bpm) and decreases in oxygen consumption (VO2) (133 +/- 19 to 69 +/- 21 mL/min) and carbon dioxide production (VCO2) (128 +/- 27 to 103 +/- 22 mL/min). However, these critical hemodynamic and metabolic variables recovered to baseline values by 15 min after stopping the CN infusion, except lactic acidosis which persisted for at least 25 min after the CN infusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Antidotal efficacy of alpha-ketoglutaric acid and sodium thiosulfate in cyanide poisoning

Alpha-ketoglutaric acid and sodium thiosulfate antagonize the toxic effects of cyanide. The present study was performed to test whether a synergistic effect may occur. The alpha-ketoglutaric acid/sodium thiosulfate solutions were injected intraperitoneally into mice prior to exposure to hydrogen cyanide (HCN) in a dynamic inhalation chamber or preceding an intraperitoneal injection of sodium cyanide (NaCN). All lethal concentration (LCT) and lethal dose (LD) values were determined after a period of 24 h. Alpha-ketoglutaric acid alone provided no protection at 250 mg/kg when challenged with HCN. Sodium thiosulfate 500 mg/kg provided a 5% protection. However, when these doses of alpha-ketoglutaric acid and sodium thiosulfate were combined, protection was increased by 18%. Alpha-ketoglutaric acid (250 mg/kg) and sodium thiosulfate (1000 mg/kg) provided an additional 48% protection against a LCT88 of HCN. A single dose of alpha-ketoglutaric acid (500 mg/kg) and sodium thiosulfate (1000 mg/kg) solutions afforded a 70% increase in survivability of the exposed animals. When mice were injected ip with 100 mg/kg of alpha-ketoglutaric acid 15 min prior to the injection of 5.5 mg/kg (LD50) of NaCN, the lethality was reduced to an LD30. Two hundred mg/kg alpha-ketoglutaric acid, challenged with the same dose of NaCN, reduced the lethality to 23%. When mice were challenged with 6.0 mg/kg of NaCN (LD70) pretreated with 100 mg/kg of alpha-ketoglutaric acid or 200 mg/kg of sodium thiosulfate, the LD was not altered in the former but reduced to an LD15 in the latter. At higher doses of sodium thiosulfate (500 mg/kg), an LD60 occurred at 13.6 mg/kg NaCN (2.5 x LD50).(ABSTRACT TRUNCATED AT 250 WORDS)

Cyanide assay: statistical comparison of a new gas chromatographic calibration method versus the classical spectrophotometric method

This work compares two different methods for assaying hydrogen cyanide, a spectrophotometric method and a headspace gas chromatographic method, each with its own reference standard generation. In the first method, the reference standards are cyanide solutions. In the second method, the reference standards are based upon the in situ reduction of ethyl thiocyanate by dithiothreitol to produce hydrogen cyanide. Furthermore, hydrogen cyanide concentration in the blood of patients who were poisoned by smoke inhalation or who committed suicide by cyanide ingestion is determined using both methods. Results are discussed using statistical comparison.

Analysis of toxic gas produced by heating tar epoxy resin paint to assess work atmosphere

Two male workers were acutely intoxicated with gas produced by heating tar epoxy resin paint, and developed peripheral neuropathy. To assess the work atmosphere, we analyzed the degradation products by GC-MS. The major toxic products emitted by heating tar epoxy resin were hydrogen cyanide, phenol, and benzene, as well as naphthalene. From 1 m2 of the surface of steel plates painted with tar epoxy resin, 2.4 g of hydrogen cyanide, 9.6 g of benzene, and 1.2 g of nephthalene were produced by heating at 1000 degrees C, At 700 degrees C, the amounts of phenol and p-isopropylphenol produced were 3.7 g and 0.57 g, respectively. Based on these results and the area of steel surface burned, the concentration of hydrogen cyanide, benzene, and phenol in the atmosphere of work environment was estimated to be 16, 64 and 24 mg/m3, respectively. Some of the symptoms of the workers including peripheral neuropathy might be related to the sole or cooperative action of the foregoing toxic chemicals mentioned above.

Clinical smoke inhalation injury: systemic effects

Exposure to asphyxiant gases is a ubiquitous feature of the fire environment, particularly in structural (or closed-space) fires. The clinician evaluating the smoke-inhalation patient must keep in mind the manifold actions of systemic toxicants upon an individual whose pulmonary gas exchange may be compromised and whose circulatory and metabolic status may be stressed by burns, hypo- or hypervolemia, and intercurrent disease. Also to be considered is the likelihood of exposure to multiple toxicants whose physiologic effects may be synergistic and whose therapeutic demands may be conflicting. As newer therapeutic regimens and rapid laboratory tests become available, the clinician should be prepared to evaluate their strengths and limitations for the complex task of evaluating and treating smoke-inhalation patients.

[Extremely varied rectal temperatures in 10 fatalities after a house fire--a contribution to the significance of body weight in cadaver cooling]

Eight children at the age of one to eleven years, their mother and uncle were victims of fire that had broken out in their flat. They all died of combined carbon monoxide cyanide poisoning. The rectal temperature of the bodies taken nearly eight hours later ranged from 16 degrees C to 29 degrees C. Using the rectal temperature time of death nomogram (Henssge 1982) with reference to corrective factors of the body weight (Henssge and Madea 1988) to find out when they died, the results corresponded with the enquiries made by the police except for three cases. The rectal temperature of the apparently intact bodies of the three youngest children whose weight ranged from 9 to 14 kilograms was comparatively high. The reason for this may be that reduction in diameter and in weight of the body causes a heating up in a smaller amount of time. This is why one has to be careful to use the nomogram with fire victims especially with those of low weight.

[Development of carbon monoxide and hydrocyanic acid in automobile fires and their forensic significance]

The presence of carbon monoxide and cyanide in the blood of traffic fire victims is reported. In addition CO and HCN was measured in the fire gas occurring in car fire.

[Toxicity of fire smoke. Apropos of 2 pediatric cases]

BACKGROUND

Smoke inhalation is one of the main cause of respiratory problems in fire-related accidents.

CASE REPORTS

Case 1. A girl, aged 11 months, was found in her apartment 15 minutes after the start of accidental fire. She was in a stage I coma with cyanosis and covered with soot. She was placed on oxygen and given hydroxocobalamin. Aggravation of respiratory problems led to mechanical ventilation. Tracheobronchoscopy showed deposits of soots with moderate burnt lesions. Intubation was discontinued 12 hours later, but the child remained oxygen-dependent, with persistent tracheobronchitis, despite steroid therapy for 2 weeks. Case 2. Another girl, aged 4 1/2 years, was found in the same room as the preceding patient. She was also covered with soot, and in a coma (Glascow score = 11). She was intubated, placed on mechanical ventilation, and given hydroxocobalamin. Tracheobronchoscopy revealed similar changes to those seen in the preceding patient. Despite repeated tracheobronchial washings and steroid therapy, respiratory problems persisted with thoracic distension and pneumothorax. Mechanical ventilation was discontinued 16 days later but at 5 1/2 years, this child still has dyspnea and has developed bronchiectasis.

CONCLUSION

Bronchopulmonary changes can be a severe complication of smoke inhalation during fires, and require early mechanical ventilation and repeated tracheobronchoscopy.