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Basics

Outline


BASICS

Overview!!navigator!!

  • The ingestion of plants containing cyanogenic glycosides can result in cyanide toxicosis. Although 55 cyanogenic glycosides have been reported (amygdalin, prunasin, and dhurrin, among others) in over 1000 different species of plants, the most important sources for animals have been the following genera: Prunus, Sorghum, Triglochin, Pyrus, Suckleya, and Amelanchier. Damage to the plant (including wilting and mastication) results in enzymatic degradation of the glycoside and release of cyanide
  • Cyanide ion has great affinity for the iron of cytochrome c oxidase and will inhibit electron transport and cellular respiration
  • The blood can carry oxygen but oxygen cannot be utilized by the cells, resulting in tissue anoxia

Signalment!!navigator!!

No breed, size, sex, or age predilection.

Signs!!navigator!!

  • Onset usually rapid (20–120 min) after large ingestion
  • Tachypnea
  • Dyspnea
  • Weakness
  • Tachycardia
  • Bright red mucous membranes
  • Recumbency
  • Terminal seizure-like activity
  • Death

Causes and Risk Factors!!navigator!!

  • Ingestion of large amounts of (usually wilted) plant material containing high concentrations of cyanogenic glycosides
  • Typical scenario is ingestion of fresh but wilted cherry leaves from branches broken off during storms
  • Reports indicate 100 g of wild black cherry leaves can be fatal to a 45 kg animal
  • Cyanide is volatile and dried cherry leaves or hay made from Sorghum spp. are generally safe

Diagnosis

Outline


DIAGNOSIS

Differential Diagnosis!!navigator!!

CO poisoning—measurement of carboxyhemoglobin in blood, CO measurement in environment, identified source for CO production.

CBC/Biochemistry/Urinalysis!!navigator!!

N/A

Other Laboratory Tests!!navigator!!

  • Cyanide analysis of blood, suspect material, or stomach contents
  • Place samples in airtight container and freeze immediately
  • Identification of suspect plant material in ingesta

Imaging!!navigator!!

N/A

Other Diagnostic Procedures!!navigator!!

N/A

Pathologic Findings!!navigator!!

  • Blood is bright red
  • Tracheal or pulmonary congestion or hemorrhage
  • Other nonspecific agonal changes may be present

Treatment

TREATMENT

  • Supportive care
  • Supplemental oxygen administration

Medications

Outline


MEDICATIONS

Drug(s) of Choice!!navigator!!

  • Treatment must be administered soon after clinical signs are exhibited to be effective
  • Sodium nitrite is used to induce a methemoglobinemia, causing cyanide to dissociate from cytochrome c oxidase and react with methemoglobin to form cyanmethemoglobin. Sodium thiosulfate will convert cyanide (by the enzyme rhodanese) to thiocyanate, which is excreted
  • Sodium nitrite 10–20 mg/kg as a 20% solution
  • Sodium thiosulfate 30–40 mg/kg as a 20% solution
  • Can be administered IV as a mixture of 1 mL of 20% sodium nitrite and 3 mL of 20% sodium thiosulfate at 4 mL per 45 kg of body weight. AC may help bind cyanide remaining in the GI tract
  • Oral sodium thiosulfate (up to 20 g in solution) might detoxify cyanide in the GI tract

Contraindications/Possible Interactions!!navigator!!

N/A

Follow-up

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FOLLOW-UP

Patient Monitoring!!navigator!!

N/A

Prevention/Avoidance!!navigator!!

Avoid additional exposure to cyanide-containing plants.

Possible Complications!!navigator!!

N/A

Expected Course and Prognosis!!navigator!!

Death or recovery occurs rapidly.

Miscellaneous

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MISCELLANEOUS

Associated Conditions!!navigator!!

  • Sorghum cystitis–ataxia syndrome has been reported in horses following exclusive, long-term grazing on Sorghum pastures
  • Syndrome is characterized by hindlimb ataxia, urinary incontinence, and subsequent skin irritation or scalding and cystitis
  • The lumbar and sacral segments of the spinal cord may have focal axonal degeneration and demyelination
  • Probably caused by thiocyanates formed from high, sublethal cyanide ingestion

Age-Related Factors!!navigator!!

N/A

Zoonotic Potential!!navigator!!

N/A

Pregnancy/Fertility/Breeding!!navigator!!

N/A

Abbreviations!!navigator!!

Suggested Reading

Cheeke PR. Natural Toxicants in Feeds, Forages, and Poisonous Plants. Danville, IL: Interstate Publishers Inc., 1998.

Cope R. Overview of cyanide poisoning. In: Aiello SE, Moses MA, eds. Merck Veterinary Manual, 11e. Kenilworth, NJ: Merck Sharp & Dohme Corp., 2016.

Author(s)

Author: Larry J. Thompson

Consulting Editors: Wilson K. Rumbeiha and Steve Ensley