Advisory notes on cyanide poisoning

Environmental Health

Advisory notes on cyanide poisoning

What are the symptoms of cyanide poisoning?
When cyanide has been eaten it may produce a bitter, pungent, burning taste in the mouth and sometimes numbness and tightness in the throat and stiffness in the lower jaw. Salivation, nausea and vomiting often follows and an odour of bitter almonds may be on the breath or vomit. Where cyanide has been inhaled the person may feel generally unwell and experience a headache, dizziness, giddiness, confusion and/or anxiety.

Patients may also experience an irregular heartbeat and tightness in the chest. In severe cases breathing becomes rapid and deep and then becomes slow and gasping. Fluid may fill the lungs and interfere with breathing. Unconsciousness, convulsions and death can quickly follow depending on the degree of exposure. A sign that is sometimes found when cyanide poisoning has occurred is a red or pink discolouration of the skin.

Where cyanide has come into contact with skin a burning sensation may be felt on the area affected and the skin may become discoloured. Where cyanide has come into contact with the eyes patients may feel a slight irritation. Very high exposures to cyanide vapour may damage the retina and the nerves of the eye.

What treatment can be offered where cyanide poisoning has occurred?
In all cases of suspected cyanide poisoning dial 111 for immediate ambulance and medical attention.

Decisions about treatment will vary depending on the circumstances, however general treatment for mild exposure to cyanide includes oxygen and bedrest. Treatment for moderate to severe exposure includes oxygen and antidotes.

Where cyanide has come in to contact with skin the area should be well flushed with plenty of water and soap. Contaminated clothing should be removed by someone wearing gloves.

Where cyanide has come in contact with eyes, the eyes should be flushed with water for at least 15 minutes.

Where cyanide has been eaten the patient should NOT be induced to vomit as the expelled stomach contents may be contaminated or hydrogen cyanide gas may also be expelled.

For more information, the National Poisons Centre website provides advice on what to do if any poisoning is suspected. The website address is: www.toxinz.com, use the search function on the site and enter ‘cyanide'.

How should people respond if someone collapses suddenly?
There is a risk at any mass public gathering some people may collapse for various reasons including sun stroke or a heart attack. There would be a real risk of unnecessary death if resuscitation was not attempted. Therefore where someone has stopped breathing and resuscitation is administered, the Ministry of Health recommends using the same precautions you would use in first aid to protect yourself from infections. Precautions may include the use of gloves or a one-way valve resuscitation mask (for example Life Aid).This advice would not apply for example in an industrial accident where the suspected level of cyanide poisoning may be much higher.

Where cyanide has been inhaled the patient should be removed to an uncontaminated area. If the patient has stopped breathing mouth-to-mouth resuscitation should be carried out using the precautions outlined above. Where cyanide has come in to contact with skin the area should be well flushed with plenty of water and soap. Contaminated clothing should be removed by someone wearing gloves. When cyanide has come in contact with eyes the eyes should be flushed with water for at least 15 minutes. For more information, the National Poisons Centre website provides advice on what to do if any poisoning is suspected. The website address is: www.toxinz.com, use the search function on the site and enter ‘cyanide'.

How safe are first responders who might treat a cyanide victim?
The police carry Life Aid resuscitators and gloves. In the unlikely event that cyanide has been ingested by someone who has collapsed, the real risk to a resuscitator utilising a Life Aid mask is very low. If the collapsed person vomits during resuscitation in open air and if that person has ingested cyanide, the risk remains low. If vapour is inhaled the resuscitator should withdraw to open air, and recovery is usually rapid. Oxygen can be administered in these circumstances to the resuscitator if required by trained health staff on site.

How much cyanide is harmful?
The lethal dose of cyanide is approximately 0.5 - 1.0 mg/kg body weight or about 70 mg for an adult.

The cyanide ion of soluble cyanide compounds is rapidly absorbed from all routes of entry, respiratory and gastrointestinal tracts, and less readily absorbed through the skin. However, accidental or intentional poisoning is more likely to involve ingestion of a cyanide salt, whereas occupational poisoning is more likely to involve inhalation of hydrogen cyanide.

What do I do if I think a product has been contaminated with a suspicious substance such as a white powder?
If you are in a shop and think a product's tamper-proof seals have been broken, notify staff at once. If you are at home and find a product contains suspicious contaminants such as white powder or crystals DO NOT TOUCH THE PRODUCT, ensure it and the packaging remains undisturbed and call the police immediately.

For more information on food tampering awareness, go to the New Zealand Food Safety Authority website, www.nzfsa.govt.nz

What advice is the Ministry of Health giving to public health units on how to minimise the risks associated with accidental or deliberate chemical poisoning?
Advice from the Ministry included:

liaising with District Health Board emergency management teams on their preparedness
ensuring a 24-hour response capacity is available at each public health unit
HSNO enforcement officers must ensure that cyanide is handled by approved handlers only
working with water suppliers and the food industry to identify and minimise risks from contamination.

Does the Ministry seek advice from experts on the risks of chemical poisoning before issuing advice?
Yes, National Poisons Centre experts are consulted. In addition, the National Poisons Centre has developed an online database on toxic and hazardous substances. Parts of this database are freely accessible to the public and give advice on what to do if any poisoning is suspected. The website address is: www.toxinz.com, use the search function on the site and enter ‘cyanide'.

What regulations govern cyanide?
Hazardous Substances and New Organisms Act 1996 (HSNO)
Agricultural Compounds and Veterinary Medicines Act 1996 (ACVM)
Health and Safety in Employment Act 1992
Land Transport Act 1998
Maritime Transport Act 1994
Civil Aviation Act 1990

Which agencies are involved in cyanide control?
Environmental Risk Management Authority administers the HSNO Act
Ministry of Health, see below
Agricultural Compounds and Veterinary Medicines Group of the New Zealand Food Safety Authority
Occupational Safety and Health - workplace health and safety
Land Transport Safety Authority - land transport
Maritime New Zealand - sea transport
Civil Aviation Authority of New Zealand - air transport

What is the Ministry of Health's responsibility with cyanide?
The Ministry of Health is an enforcement agency under the HSNO Act to ensure that the provisions of this Act are enforced where it is necessary to protect public health.

For the roles and responsibilities of other agencies, please contact them.

In what form is cyanide sold?
Cyanide is sold in a variety of forms such as granules, powder, paste or encapsulated cyanide pellet.

What does cyanide look like?
This depends on the nature of the cyanide and its intended use. For example sodium cyanide used in manufacturing jewellery is a white powder. Cyanide in paste form used for pest control looks like a gel or paste.

Is an approved handler test certificate required for cyanide?
Under the Hazardous Substances and New Organisms (HSNO) Act, anyone handling cyanide (of classification 6.1A, 6.1B or 6.1C) must hold a valid approved handler test certificate that covers the specific substance(s) being used. This certificate ensures you are trained in how to use or manage cyanide safely and understand the laws and controls (rules) under the HSNO Act. This requirement is relevant for all uses and applications of cyanide.

In addition, if you have access to Vertebrate Toxic Agents (VTAs) containing cyanide, you must also have a Controlled Substances licence (CSL). This licence ensures that high risk substances are only possessed by fit and proper persons, much like a firearms licence, and also requires evidence that the substance is required for a person’s work. ‘Possession’ may include manufacturing, selling, using, storing or disposing of the substance.

Approved Handler Test Certificates and CSLs are issued by Test Certifiers. Further information on CSLs can be found at http://www.ermanz.govt.nz/hs/compliance/cs-licence.html

What regulations does a seller of cyanide have to conform with?
A seller of cyanide must comply with the requirements prescribed under the HSNO Act. Contact ERMA New Zealand on 04-916 2426 or visit their website http://www.ermanz.govt.nz/hs for additional information.

Page last updated: 23 October 2008