I have been working on the pathophysiology of Cyanide poisoning I believe that I have captured this correctly, but would love a second a opinion..
Pathophysiology: Cyanide exposure can be a result of inhalation, ingestion or absorption. Once this has entered the body it is rapidly spread to the organs of the body. Inside the cells of the body the cyanide binds to ubiquitous metalloenzymes, rendering them inactive for use. The primary reason toxicity causes by cyanide poisoning is a result of the inactivation of cytochrome oxidase at cytochrome A3.
Intracellular, cyanide attaches itself to ubiquitous metalloenzymes, rendering them inactive. The toxicity results from inactivation of cytochrome oxidase and further uncouples mitochondrial oxidative phosphorylation and inhibiting cellular respiration even in the presence of excessive oxygen saturation during treatment. Because of this cellular respiration shifts from aerobic to anaerobic, causing a rise is lactic acid. Because of this process the brain and heart which are at the highest risk due to the additional oxygenation required for normal homeostatic purposes.
One type of treatment (Antidote) of cyanide positioning can be to convert (oxidize) ferrous ions in hemoglobin to ferric ions. This forms methemoglobin, which is hemoglobin with ferrous ion in the oxidized state. Cyanide which has a greater attraction to these ferric states of the cells. Because of this the cyanide is released from the cytochrome oxidase and combines with the newly created methemoglobin. This process allows cytochrome oxidase to results its function in cellular respiration.
Methemoglobin cannot transport oxygen, so without counter measures this will result in further tissue damage and necrosis. So this all forms part of a 3 phase treatment plan that is aimed at restoring the hemoglobin to its original state. Through the administration of amyl nitrate, sodium nitrate the conversion of ferrous hemoglobin to methemoglobin to capture the cyanide molecules, Further to this administration of hydroxocobalamin with or without sodium thiosulfate allows the detoxification to be completed and cellular respiration recommence.
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