By

Dr.Nirmala Perera

Irritant Gases- causes irritation of the
respiratory tract

Simple Asphyxiants- interferes with
gaseous exchange only. They are not
absorbed

Clinical Asphyxiants- Are absorbed into the
lungs and causes various actions

Eg combines with Hb
Causes haemolysis
Interfere with cellular oxidation
Depress the brain and causes respiratory depression
and paralysis



Simple asphyxiant gas

Sources- In anaesthesia,

Industrial- eg. Mines, disused wells, pits, ship
holds, burning of lime, wood & coal, Breweries
Mineral water plants

Normal levels- O.3%
> 3% - Headache, drowsiness, dizziness,
giddiness, muscle weakness ( prevents running
away from the area)

10% - loss of consciousness

25-30% - minimal fatal concentration

60- 80% Instance collapse and death (tissue
anoxia)
It is odourless, rapidly absorbed when inhaled and
combines with haemoglobin to form carboxy-
haemoglobin which is stable than oxy-
haemoglobin.

The affinity of CO for Hb is more than Oxygen
Coal gas

Exhaust fumes of motor vehicles and other engines
Incomplete combustion in closed surroundings

Industrial gases

Circumstances : Suicidal and accidental




The symptoms depends on the blood
concentration of CO

Up to 20% - no symptoms

3%- street cleaners, traffic policemen

5%- heavy smokers

20% - Headache, dizziness and malaise

30% - giddiness & mild shortness of breath

40% - Confusion, in-coordination, staggering,
fatigue of muscles


50%- drunken gait, slurred speech,
incoordination, exhaustion, vomiting, flushing,
sweating & pink colour of skin (mimics
drunkenness and drug intoxication)

60% - respiratory distress, dilated pupils, loss of
consciousness
70% - coma & death

History of exposure

Pink colour

Clinical features

Blood analysis( 5-10ml of blood with anti-
coagulant)
Pink colour of the skin, hypostasis, blood and
internal organs

Symmetrical softening of the basal ganglia

Hypostatic pneumonia (delayed death)

SOURCES

Cyanide Gas
Fumigation of ships
Spraying in fruit orchards
Cyanide salts
Used in electroplanting, gold
plating, photography & engraving
Laboratory use
Cyanide capsules

Cyanogenic Glycosides in plant
material

SUICIDE-
Biting of cyanide capsule by terrorists
Ingestion of liquid potash by those in the
jewellery/electroplating trade
Ingestion by laboratory workers

ACCIDENTAL
Faulty fumigating techniques
Laboratory accidents
Plant material
HOMICIDAL
Introduced into food or drink
War gas used in world war 1
Gas chambers in Germans in world war II
Execution by cyanide gassing/ingestion (USA)
TWO FOLD ACTION

Inhibits the enzyme Cytochrome Oxidase

Acts as a corrosive because of its alkaline radical

The rapidly absorbed cyanide is carried to the
tissues in the blood stream
A cellular poison
Strong affinity between cyanide and cytochrome
oxidase
Interfere with cellular utilization of oxygen
The cell cannot use oxygen although there is
abundance of it in the blood stream
Cause cellular anoxia- Histotoxic or cytotoxic
anoxia
SMALL DOSES
Vertigo, headache, difficulty in breathing, loss of
muscle power & giddiness

LARGE DOSES
Rapid loss of consciousness, collapse, twitching,
convulsions & death
The same is true for higher concentration of cyanide
vapour
History
Clinical features
Pink colour of extremities
Smell of bitter almonds in the breath
The ability to smell is an inherited character.

Red colour of skin, hypostasis, blood and
vascular organs
Odour of bitter almonds or may be ammonia
Diffusely red mucosa of the GIT with or
without areas of corrosion
Remnants of the capsule with cut injuries in
the mouth

Embalming with formalin will rapidly
destroy cyanide

Postmortem decomposition produce traces
of cyanide


Carbon dioxide- Accidental poisoning
Co Suicidal and accidental poisoning
possible
CN- Suicidal and accidental poisoning
possible