in the previous video we have discussed
cyanide poisoning today let’s talk about how to diagnose and how to treat this
evil poison remember the most common cause in the United States are fires so
firefighters any person who was involved in the fire and don’t forget they tried
poisoning Rasputin by giving him cyanide. Music Playing…🎶 And these are just a couple of my
previous videos, so make sure to subscribe. As you know from the previous
lectures, Cyanide could be gas, liquid or solid. Cyanide poisoning could be due to
inhalation, ingestion or skin absorption. Causes of cyanide poisoning; smoke
inhalation is the most common cause in United states by far.
suicide ingestion so, pharmacists, doctors, nurses. Medication such as: sodium
nitroprusside. Industrial exposure and the polyurethane in the famous foam
bubble wrap, just the one that you keep like picking with your fingers. I love it,
that’s why I’m crazy, because of the cyanide. Cyanide loves binding to ferric
therefore cyanide will either bind to ferric in the Met hemoglobin, or will
bind to the ferric in the cytochrome C oxidase in your mitochondria. In the
absence of met hemoglobin, cyanide have no choice, but to bind to the ferric in
the cytochrome C oxidase. Now this enzyme is gone: irreversible binding. This is
an enzyme inhibition. This complex 4 is now gone. Oxygen cannot act as an
electron acceptor therefore we will go to an aerobic glycolysis as a source for
our energy because ATP from the electron transport chain is no longer viable and
as you know this pathway is not gonna work when you have no met hemoglobin but
when you are relatively lucky and you have met hemoglobin it will bind cyanide
forming cyano met hemoglobin by the liver Rhodanase, thanks to sodium
thiosulfate, we end up with thiocyanate, which contains cyanide, and it’s gonna be
excreted in the urine. Go to hell, cyanide. Go multiply by
yourself. Some people will never get this joke. Cyanide binds ferric in the
cytochrome oxidase which will lead to inhibition of complex 4… what is
complex 4 ?! -Cytochrome a/a3 …Now, no ATP formation, mitochondria cannot
utilize oxygen, we will shift to anaerobic glycolysis which will lead to
lactic acid, lactic acidosis, metabolic acidosis. What type? – High anion gap
metabolic acidosis. What’s the normal anion gap?
-It’s less than 12 …Now when your tissue cannot use oxygen, the concentration
gradient between hemoglobin and tissue is different… So, here is the red blood
cell which contains the famous hemoglobin and here is your tissue
normally your tissue is using lots of oxygen lots of oxygen lots of oxygen
which makes the concentration of oxygen on the hemoglobin greater than the
concentration of oxygen in the tissue which will lead to a diffusion
concentration gradient down the concentration gradient down this
concentration gradient but now your tissue is not using oxygen so there is
no concentration gradient for oxygen to flow from hemoglobin to the tissue
oxygen is gonna stay on the hemoglobin from passing it to the artery then to
the vein because there is no oxygen going to the tissue because your
mitochondria cannot utilize oxygen which destroys the concentration gradient
there is no gradient there is no flow to the tissue the venous oxygen content is
high as high as the artery that’s why in cyanide poisoning pao2 which is the
partial pressure of oxygen in the artery equals the P vo2 which is the partial
pressure of oxygen and vein some words of wisdom in cyanide poisoning despite
the abundance of oxygen it cannot be utilized by the mitochondria that’s how
it ends up in the vein eating lots of apricots and almonds is
bad for you why they contain amygdalin which is hydrolyzed into hydrogen
cyanide one apple a day keep the doctor away
lots of almonds a day mitochondria has gone astray eating lots of almond will
lead to cyanide poisoning however in cyanide poisoning the patient’s breath
smells like bitter almond just fascinating so here is our nice
firefighter who serves his community I serve and protect and smelt like almond
now if your doctor is going to test your ability to answer the question about
cyanide poisoning correctly they will use one of these scenarios
the firefighter in coma with almond like breaths after a fire patient who was
prescribed sodium nitroprusside suddenly collapses
he has metabolic acidosis why because of the lactic acidosis the factory worker
in the middle industry who comes to the ER comatose after an explosion in the
mill a pharmacist who suffer from major depressive disorder presents with
confusion seizure and loss of consciousness hatred cyanide clinically
we have symptoms and we have signs what is the difference between symptom and
sign symptom is what you as a patient complain of signs are what I as a great
doctor discover or observe so symptoms weakness why there is no ATP the
electron transport chain is gone tissue hypoxia yes the tissue is not getting
enough oxygen the mitochondria is not utilizing oxygen so the oxygen is not
gonna flow from the hemoglobin to the tissue epidermal pain chest pain
neurological problems such as headache very important vertigo dizziness seizure
in coma all of them are the same as in carbon monoxide poisoning now signs
dilated pupils diaphoresis which is excessive sweating because we don’t say
sweating like the normal public we are sophisticated we say diaphoresis which
just means sweating arrhythmia yep cardiovascular collapse possible
decrease heart rate decrease blood pressure increased respiratory rate yep
shorts of breath and the important cherry cherry red skin why because the
partial pressure of oxygen in the vein is high and what gives your blood the
bright color at least the arterial blood is the oxyhemoglobin when you have lots
of oxyhemoglobin in the vein the vein is gonna look like the artery bright red
that’s why your skin will look cherry red in color because your veins are more
superficial than your arteries don’t waste your time on crap and let’s go to
the lab arterial blood gases venous blood gases
what we’re gonna find how about the partial pressure of oxygen in the artery
normal partial pressure of vein on the oxygen higher than normal
why because oxygen is not going to the tissue because we have destroyed the
concentration gradient pao2 now roughly equals P vo2 partial
pressure of oxygen the artery partial pressure of oxygen in the vein and
partial pressure is not the oxygen that’s on the hemoglobin it’s the oxygen
in the bloodstream AV oxygen difference is decreased it’s less than 10%
what is AV oxygen difference it’s the difference between oxygen concentration
in the artery and the vein they are now relatively equalizing high anion gap
metabolic acidosis due to the lactic acidosis in high anion gap metabolic
acidosis it’s a freaking acidosis so pH is low what’s the normal pH from 735 to
745 so the pH and patients with cyanide is going to be less than 735 important
decrease bicarbonate because it’s a freaking metabolic acidosis increased
anion gap more than 12 okay what’s the anion gap it’s the
positive ions on one end and the negative ions on the other end and the
difference between them is called the anion gap there is no actual gap it’s a
gap in our knowledge it’s a gap in our measurement blood lamps we have
increased blood lactate level greater than 10 increased plasma cyanide
concentration the EKG nonspecific findings sinus tachycardia being the
most common carboxy hemoglobin concentration to rule out CO poisoning
because both of them are abundant in fires met hemoglobin level why to
monitor therapy because we don’t want to give the patient too much
methemoglobinemia global is also bad you remember methemoglobinemia pros it can
treat cyanide poisoning but we can’t go too far because met hemoglobin can kill
you please let me remind you of normal
physiology then we’ll discuss the effect of cyanide on each one
those you breathe an air the air has oxygen the percentage of oxygen as
compared to the atmospheric air is called fio2 normally 21% oxygen goes to
the lungs in the alveoli it’s called P big AO – that goes to the arterial blood
it’s called P small a o2 then jumps on the hemoglobin called si O 2 jumps the
tissue the tissue needs oxygen for the electron transport chain and it produces
carbon dioxide goes to the hemoglobin this is called oxy hemoglobin this is
called carb amino hemoglobin not carboxy carb amino that goes to the venous blood
it’s P vo2 then back to the lungs you exhale carbon dioxide so what’s the
effect of cyanide on each one of those how about the fio2 it’s perfectly normal
okay so I nod has no say on that how about P big a o2 in the alveoli again
it’s normal how about P small a o2 normal sao to normal but how about the
partial pressure of oxygen in the vein it’s high oxygen content a called
hemoglobin concentration plus PA o2 plus si o – what’s the effect of cyanide on
hemoglobin concentration normal anemia decreases your hemoglobin concentration
but not cyanide poisoning about pao2 same thing normal sao to normal so the
oxygen content in cyanide poisoning normal believe it or not and here I’m
talking about the arterial oxygen content but how about the venous oxygen
content it’s increased in cyanide poisoning if io2 is normal P big a o2 is
normal P small a o2 is normal it’s a Oh – is normal P vo2 is increase don’t ever
forget that is the cell affected yes indeed it’s affected the mitochondria
cannot utilize oxygen so oxygen is released from hemoglobin to tissue but
it cannot utilize it but didn’t you say that oxygen is not released in the
beginning it is released but then the mitochondria doesn’t use it so the
oxygen doesn’t flow anymore but the problem is not from oxygen being able to
leave the hemoglobin and going to the tissue that’s why
generally speaking the cyanide poisoning does not shift the oxygen binding curve
some words of wisdom from the father of Medicine Hippocrates I will use my power
to help the sick to the best of my ability I will abstain from harming or
wronging any man by it I have a terrible British accent plus Hippocrates was
Greek he was not British what am I doing with my life so let’s use our power to
help the sick and let’s learn how to manage cyanide poisoning first remove
the clothes why because cyanide poisoning can occur
by absorption through the skin and don’t waste your time
unbuttoning each button with care because the shirt of the patient was
expensive just get them off don’t be an SS s what I call a super
sophisticatedly stupid then wash the body with soap and water do not wait for
the stupid labs if you suspect cyanide treat it how to
treat saina 100% oxygen then we try the hyperbaric oxygen then the hyperbaric
chamber remember your ABCs first airway breathing circulation establish an IV
line and continuous EKG monitoring give the cyanide antidote what is the sign of
antidote the famous triad hydroxocobalamin sodium nitride sodium
thiosulfate let’s talk about sodium thiosulfate sodium thiosulfate helps the
Sanomat hemoglobin goes to thiocyanate then become excreted in the urine
go to hell cyanide go multiply by yourself sodium nitrite converts the
normal hemoglobin into meth hemoglobin so the methemoglobinemia with cyanide
forming cyano met hemoglobin then the sodium thiosulfate will kick in
converting them to thiocyanate which will be excreted in the urine so here is
the famous giant hydroxocobalamin sodium
thiosulfate and sodium nitrite sodium nitrite converts the hemoglobin into met
hemoglobin the Farrah’s into ferric then the methemoglobinemia forming cyano met
hemoglobin level rhodanese sodium thiosulfate they’ll form thiocyanate
excreted in the urine go-to-hell hydroxocobalamin on the other hand
combines directly with cyanide forming cyano cobalamin again they are excrete
is excreted in the urine and that’s how the evil cyanide ends up in the urine
magnificent repetition is the mother of pedagogy here we have the hemoglobin
phorus thanks to sodium nitrite now we have the met hemoglobin which contains
furyk cyanides loves ferric without the met hemoglobin cyanide will be able to
bind the complex for the cytochrome a a3 in the electron transport chain
destroying your mitochondria destroying your cellular respiration but now net
hemoglobin has gone distract cyanide and take it away forming Cyanamid hemoglobin
sparing the mitochondria from the grief then cyan homuth hemoglobin thanks to
sodium thiosulfate is gonna be converted into FeO
cyanide thio cyanide how about the methemoglobinemia hemoglobin we can use
methylene blue to return it back to hemoglobin later but now let’s get rid
of the sanno matimak globin use sodium thiosulfate now we have thiocyanate go
to hell so we have mentioned two of the triad sodium nitrite and sodium
thiosulfate how about the third one hydroxocobalamin vitamin b12 guys
hydroxocobalamin will bind cyanide forming cyano cobalamin go to hell
without this amazing triad your cellular respiration will be inhibited you will
end up smelling like bitter almond with cherry red skin until you die for a plus
students while treating acute cyanide poisoning do not give methylene blue
why because methylene blue will confer the methemoglobinemia back into regular
hemoglobin okay so don’t do this wait until we clear all the sign out from the
system then you can give methylene blue to convert the methemoglobinemia great
normal hemoglobin do not let me t mclogan level rise too much we don’t
want to go too far yes Matt hemoglobin is beneficial in treating cyanide
poisoning by using too much methemoglobinemia hemoglobin amine which
is also a disease so everything has to be balanced sodium nitroprusside leads
to cyanide poisoning whereas sodium nitrite and sodium thiosulfate treats
this poisoning this is very important and most students confuse these sodium
nitroprusside is evil it leads to cyanide poisoning sodium nitrite and
sodium thiosulfate they treat the cyanide poison sodium nitroprusside and
cyanide and sodium nitrate and sodium nitrite all lead to hypotension that’s
why men die on viagra when they are using sodium nitrate both viagra and
sodium nitrate will drop the blood pressure leading to either death or
reflex tachycardia which will also lead to death in cyanide poisoning it’s
difficult to distinguish between original arteries and retinal veins
under Fonda’s copic exam which is a brilliant point why because the partial
pressure of oxygen in the artery calls the partial pressure of oxygen in the
vein and oxygen is what gives the vessel its bright color
that’s why normally arteries have bright red blood all veins have dark but now we
can’t differentiate between arteries and veins both of them are bright guys it
can’t get better than that so please join me on patreon com4 / meta kosis and
thank you so much for watching my videos until next time be safe stay happy and
study hard I’ll see you in the next video we have a crazy mnemonic about
cyanide poisoning until next time

14 thoughts on “Cyanide Poisoning Diagnosis and Treatment”

  1. Continue doing a great job. You are strongly talented in teaching in a way that is easy to remember and easy way to understand.

    In other words you make difficult concepts/diseases easy to understand.

    You convert the difficult into easy..

    Keep up the excellent work!!!

  2. Please, help me reach 35,000 subscribers and I will start uploading videos on “bleeding and coagulation disorders” instantaneously.
    Thanks 🙏

  3. I think I ingested Cyanide in candy from halloween. My stomach hurts like hell, I have a headache, I feel like I'm going to puke, and I'm dizzy. The piece of candy I ate had a lil tear but I didn't think anything of it. What should I do?

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