Analytical techniques for cyanide in blood and published blood cyanide concentrations from healthy subjects and fire victims

Hydrogen cyanide can be produced by the pyrolysis of man-made polymers. Cyanide has been measured in the blood of healthy adults as well as the blood of fire survivors and fatalities. In healthy subjects the blood cyanide concentration of smokers is higher than that of non-smokers. Fire survivors and fatalities have been found to have higher cyanide levels than of control groups and the levels from fire fatalities are often higher than survivors. Blood concentrations quoted as normal, toxic or fatal are highly variable in the literature. Many studies have been performed to measure the blood cyanide levels in control subjects as well as those who have been exposed to fire but the values found differ. The values for control subjects can vary from none detected to 19 mumol dm(-3) while those for fire survivors range from not detected to 150 mumol dm(-3) and fatalities range from not detected to 284 mumol dm(-3). Analytical techniques and published data are critically reviewed. Many of the existing antidotes for cyanide poisoning are highly toxic themselves and should ideally be administered at doses proportional to the amount of cyanide a patient has received to avoid compounding damage done by cyanide intoxication. For this reason, a rapid, accurate bedside assay of blood cyanide concentration that differentiates between bound and free cyanide would represent a leap forward in the clinical management of cyanide poisoning, (C) 2004 Elsevier B.V. All rights reserved.