[From Brian Harmon] Some time ago, I mentioned that i had a source or two mentioning that cyanide passing thru the skin was not a major mode of poisoning. It took me some time, but i dug out a couple of sources from my photocopied pile of stuff. The first is from an article in _American Family Physician_, July '93, V48 n1. on page 109: "Cyanide is readily absorbed by the mucous membranes and eyes. Clinical cases of cyanide poisoning after dermal [skin] exposure are rare and have most oten involved burns with molten cyanide salts or immersion in cyanide solutions." Not much, really, but it's something. This quote is included in ftp://nizkor.almanac.bc.ca/pub/camps/auschwitz/cyanide/cyanide.001 Something i never noticed before, however, is the article mentions how to clinically diagnose cyanide poisoning. This kind of thing could be very useful in smashing the denier's crying foul that no one did an autopsy report on the gassed victims. We already know that none the corpses were around long enough for allied doctors to have carried out the autopsy, as the gassing stopped months before Auschwitz fell. We might be able to take away there other argument by showing that clinical diagnosis of cyanide poisoning is difficult on living people, let alone those who have been dead for some time. On page 110: Clinical Evaluation History and Physical Examination A pertinent history in a patient suspected of cyanide poisoning may include occupation and hobbies, medications, diet, smoking habits, and drinking water source. Physical examination of chronically exposed petition should include particular attention to neuropsychiatric, opthalamologic, and cardiovascular systems, as well as thyroid function Because cyanide can kill quickly, acute poisoning must be rapidly treated. Unfortunately, diagnosis is often difficult, especially when the history cannot be obtained. Knowledge of the patient's occupation, mental status before poisoning, probability of suicicidal intent or location at onset of symptoms can be vital in making a diagnosis. and on page 111: Acute Signs and Symptoms [without going into the details, this lists ways to diagnose people who are _still alive_ including cardiovascular signs (ST segment length), breathing, etc.] ...Retinal veins and arteries may appear red in color as cyanide blocks cellular utilization of oxygen, elevation venous PO2 [pressure of oxygen] [..] Non cardiogenic pulmonary edema may be noted after cyanide inhalation or ingestion. Because of increased venous PO2 and percent oxygen saturation, cyanosis may be absent despite respiratory depression. Severe metabolic acidosis results from anearobic metabolism with increased lactic acid production. [..] Laboratory Tests Direct Biological indicators _Blood Cyanide Concentration_. Laboratory analysis of the whole-blood cyanide concentration takes at least four to six hours, and theraputic interventions usually must be made before results are available. However, determination of whole-blood cyanide levels is useful in confirming and documenting the diagnosis. One of the most significant problems in measuring cyanide is its instability in collected samples. A laboratory should be consulted for proper techniques in speciment handling. [discussion about how much cyanide is bad deleted] Indirect Biological Indicators _Plasma or Serum Thiocyanate Level_ Cyanide in the body is biotransformed into thiocyanate. [..] Thiocyanate can be measured in serum or plasma, but interpretation of levels in a cyanide-poisoned patient is difficult. Little correlation has been found between simultaneously obtained whole-blood cyanide and plasma thiocyanate levels. ===== A summary and comment: * Cyanide poisoning causes metabolic acidosis: this wouldn't be helpful, as asphyxiation also causes acidosis as CO2 builds in the blood. * Red venoous blood/higher O2 concentration in blood: this won't be too helpful once the victim is dead and stops breathing. Higher O2 can also be caoused by many other things. * Whole blood cyanide: Given the instability of the samples, this could be duff too, but it
work. * Plasma thiocyanate levels: Given that the victims died within minutes of gassing, i doubt their livers will have much time to change any of the cyanide to thiocyanate. The other diagnoses mentioned only work for people who are still alive (dyspnea, cardiovascular function, disorientation, etc.) Even still, the article makes no bones about it: diagnosing cyanide exposure is no easy task. I have the whole article here, so i can photocopy and mail it out to you. -- Brian.
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