A Review on Ingested Cyanide: Risks, Clinical Presentation, Diagnostics, and Treatment Challenges

Area of Science:

• Environmental toxicology
• Emergency medicine
• Pharmacology

Background:

• Cyanide is a metabolic poison and a growing chemical threat, with ingestion being the most common exposure route.
• Potential terrorist threats target food and water supplies, increasing the risk of mass cyanide exposure.
• Oral cyanide exposure presents unique toxicokinetic and toxicodynamic profiles, leading to severe symptoms and delayed onset.

Purpose of the Study:

• To evaluate the risks and unique toxicokinetics of oral cyanide exposure.
• To address the critical lack of rapid diagnostics and effective treatments for mass casualty cyanide events.
• To review current strategies for developing novel cyanide antidotes.

Main Methods:

• A comprehensive literature review was conducted using the PRISMA checklist.
• 7284 articles were identified, 1091 screened, and 59 included for analysis.
• Included articles focused on risk, clinical presentation, diagnostics, current treatments, and developing therapies for cyanide poisoning.

Main Results:

• Current cyanide diagnostics can take hours to days, delaying critical treatment.
• Existing cyanide poisoning therapies are primarily intravenous and not optimized for oral exposure, which can lead to higher doses and altered effects.
• There are no FDA-approved oral or intramuscular therapies for cyanide ingestion, particularly for mass casualty scenarios.

Conclusions:

• Rapid diagnostics and easily administered, safe, and effective oral therapies are urgently needed for mass cyanide poisoning events.
• Current research focuses on developing new antidotes with rapid onset of action suitable for first responders.
• Addressing the specific challenges of oral cyanide exposure is crucial for public health preparedness.