Fatality from potassium gold cyanide poisoning.

While potassium cyanide poisoning has been well described, the toxicity of potassium gold cyanide is less well understood. This case describes an 84-year-old man who presented after an intentional ingestion of 0.5-1 teaspoons of potassium gold cyanide. Despite antidotal therapy, the patient rapidly developed severe lactic acidosis, multiorgan dysfunction and ultimately expired. While the patient's clinical findings were consistent with acute cyanide poisoning, a serum cyanide level was below the toxic threshold. Previous reports have suggested that gold toxicity may also contribute to the effects of potassium gold cyanide, and may have played a role in the patient's rapid decline. In addition to treatment of cyanide toxicity, management of acute gold toxicity should also be considered in potassium gold cyanide ingestion.

Pseudolaminar necrosis in cyanide intoxication: a neuropathology case report.

We describe the gross and microscopic neuropathological changes in the brain of a 17-year-old male who died 4 days after being poisoned with cyanide. Previous reports indicate that following cyanide intoxication, the brain develops diffuse hypoxic/ischemic changes, predominantly of the basal ganglia. The case we describe here had similar features but in addition showed striking laminar necrosis of the cerebral cortex. This finding in cyanide poisoning has been previously demonstrated by neuroimaging, but not pathologically.

Possible use of constructed wetland to remove selenocyanate, arsenic, and boron from electric utility wastewater.

Wetland microcosms were used to evaluate the ability of constructed wetlands to remove extremely high concentrations of selenocyanate (SeCN-), arsenic (As), and boron (B) from wastewater generated by a coal gasification plant in Indiana. The wetland microcosms significantly reduced the concentrations of selenium (Se), As, B, and cyanide (CN) in the wastewater by 64%, 47%, 31%, and 30%, respectively. In terms of the mass of each contaminant, 79%, 67%, 57%, and 54% of the Se, As, B, and CN, respectively, loaded into the microcosms were removed from the wastewater. The primary sink for the retention of contaminants within the microcosms was the sediment, which accounted for 63%, 51%, and 36% of the Se, As, and B, respectively. Accumulation in plant tissues accounted for only 2-4%, while 3% of the Se was removed by biological volatilization to the atmosphere. Of the 14 plant species tested, cattail, Thalia, and rabbitfoot grass were highly tolerant of the contaminants and exhibited no growth retardation. Environmental toxicity testing with fathead minnow (Pimephales promelas) larvae confirmed that the water treated by the wetland microcosms was less toxic than untreated water. The data from the wetland microcosms support the view that constructed wetlands could be used to successfully reduce the toxicity of aqueous effluent contaminated with extremely high concentrations of SeCN-, As, and B, and that a pilot-scale wetland should therefore be constructed to test this in the field. Cattail, Thalia, and rabbitfoot grass would be suitable plant species to establish in such wetlands.

Sodium cyanate alters glutathione homeostasis in rodent brain: relationship to neurodegenerative diseases in protein-deficient malnourished populations in Africa.

Sodium cyanate, a neurotoxic chemical in rodents, primates and humans, is implicated in neurodegenerative disorders in protein-deficient populations subsisting in parts of Africa on the cyanogenic plant cassava. The molecular and cellular mechanisms of cyanate neurotoxicity are not understood. This study investigates the effect of sodium cyanate on glutathione (GSH) homeostasis in rodent brain and liver in vitro and in vivo. GSH levels in mouse brain were rapidly, time- and dose-dependently decreased following intraperitoneal administration of 100, 200 or 300 mg/kg sodium cyanate. By contrast, GSH disulfide (GSSG) levels were increased and GSH/GSSG ratios were decreased in a dose-dependent manner in rat brain. Sodium cyanate depleted GSH levels in all regions of mouse brain. Brain glutathione reductase activity was dose-dependently inhibited, while glutathione peroxidase activity was not affected by sodium cyanate. The disruption of GSH homeotasis, as evidenced by reduced tissue GSH/GSSG ratios, likely results from cyanate-induced inhibition of glutathione reductase activity. The results of this study suggest that cyanate neurotoxicity, and perhaps cassava-associated neurodegenerative diseases, are mediated in part by disruption of glutathione homeostasis in neural tissue.

Monitoring of haemoglobin-methyl isocyanate adduct by high-performance liquid chromatography with diode array detector.

Carbamylation of haemoglobin by methyl isocyanate (MIC) was detected by high-performance liquid chromatography (HPLC) using a photodiode array detector following cyclisation of the N-terminal valine into methyl isopropyl hydantoin (MIH). MIH was also synthesised by reaction of MIC with valine, the chromatographic conditions standardised and the spectrum derived by a photodiode array detector recorded for confirmation of the identity of MIH. This HPLC method is specific, sensitive and suitable for the detection of exposure of blood samples to methyl isocyanate.

Health effects of the Bhopal gas leak: a review.

The methyl isocyanate (MIC) gas leak from the Union Carbide plant at Bhopal, India in 1984 was the worst industrial disaster in history. Exposure estimates of gas concentrations in the area range from 85 to 0.12 ppm. Of the approximately 200,000 persons exposed, 3598 deaths have resulted as of November 1989. Chronic inflammatory damage to the eyes and lungs appears to be the main cause of morbidity. Reproductive health problems in the form of increased spontaneous abortions and psychological problems have been reported. Questions about the nature of MIC toxicity have been raised by the persistence of multi-systemic symptoms in survivors. Animal studies using radio-labeled MIC given by the inhalation route have shown that the radio-label is capable of crossing the lung membranes and being distributed to many organs of the body. This paper reviews health effects of gas exposure from published studies and discusses some of the clinical and epidemiological issues being debated.

Sequential respiratory, psychologic, and immunologic studies in relation to methyl isocyanate exposure over two years with model development.

Of 113 methyl isocyanate (MIC)-exposed subjects studied initially at Bhopal, India, 79, 56, 68, and 87 were followed with clinical, lung function, radiographic, and immunologic tests at 3, 6, 12, 18, and 24 months. Though our cohort consisted of subjects at all ages showing a varied severity of initial illness, fewer females and young subjects were seen. Initially all had eye problems, but dominant symptoms were exertional dyspnea, cough, chest pain, sputum, and muscle weakness. A large number showed persistent depression mixed with anxiety, with disturbances of personality parameters. The early radiographic changes were lung edema, overinflation, enlarged heart, pleural scars, and consolidation. The persistent changes seen were interstitial deposits. Lung functions showed mainly restrictive changes with small airway obstruction; there was impairment of oxygen exchange. Oxygen exchange improved at 3-6 months, and spirometry improved at 12 months, only to decline later. The expiratory flow rates pertaining to large and medium airway function improved, but those for small airways remained low. There were changes of alveolitis in bronchoalveolar lavage fluid on fiber optic bronchoscopy, and in 11 cases positive MIC-specific antibodies to IgM, IgG, and IgE were demonstrated. On follow up, only 48% of the subjects were clinically stable, while 50% showed fluctuations. Thirty-two percent of the subjects had lung function fluctuations. Detailed sequential behavior over 2-4 years was predicted for dyspnea, forced vital capacity, maximum expiratory flow rate (0.25-0.75), peak expiratory flow rate, VO2, and depression score. A model for clinical behavior explained a total variance of 52.4% by using the factors of cough, PCO2 and X-ray zones in addition to above five parameters. The behavior of the railway colony group (1640 patients) revealed a similar pattern of illness. When this observed pattern of changes was transferred to the affected Bhopal city sections (with an equitable age-sex distribution), our model results were again validated. Thus the picture of MIC-induced disease seems similar despite the differences for age-sex and initial severity of illness in our cohort and in the population of Bhopal city as predicted by our model.

DNA damage in human white blood cells after inhalative exposure to methylenediphenyl diisocyanate (MDI)--case report.

A workplace-related inhalative exposure test in a challenge chamber was performed on an industrial worker in a methylenediphenyl diisocyanate (MDI) atmosphere from 5 to 20 ppb and the isolated white blood cell DNA was analysed by electrophoresis, anion-exchange chromatography and melting behaviour. The results of electrophoresis indicate that inhaled MDI induces double-strand breaks of DNA. Some of the DNA fragments were estimated to be in the region of 100-500 bp. Anion-exchange chromatography confirmed this finding. Following denaturation and rapid renaturation the results demonstrated that some DNA fragments are cross-linked by MDI. Comparing the melting curves before and after inhalative exposure in the challenge test chamber, genomic DNA revealed differences in the shape of the melting curve (hyperchromic effect). The results suggest that occupational MDI exposure could be associated with white blood cell DNA damage.

Mass deaths by gas or chemical poisoning. A historical perspective.

This review chronicles the characteristics of deliberate and accidental mass poisonings that occurred in World Wars I and II, in Bhopal, and in other historical cases up to and including modern wars. It also considers approaches to the investigation of such cases from the medicolegal as well as general standpoints.

Delayed eye and other consequences from exposure to methyl isocyanate: 93% follow up of exposed and unexposed cohorts in Bhopal.

A follow up study three years after exposure to methyl isocyanate in 93% of exposed survivors and "control" residents in 10 Bhopali communities showed an excess of eye irritation, eyelid infection, cataract, and a decrease in visual acuity among the exposed people. Breathlessness was twice as common in the heavily exposed clusters as those with lower exposure, a trend that could not be explained by different age or smoking patterns (OR 2.05, 95% CI 1.36-3.08). Case referent analysis of outpatient attendances at Bhopal Eye Hospital, considering patients with severe refractive errors and astigmatism as "controls," showed a 40% increased risk of trachoma, 36% increased risk of other lid infections, and 45% increased risk of irritant symptoms among previously exposed people. "Bhopal eye syndrome" may thus include full resolution of the initial interpalpebral superficial erosion, a subsequent increased risk of eye infections, hyperresponsive phenomena (irritation, watering, and phlyctens), and possibly cataracts. It remains to be confirmed whether this reflects a more generalised disease as a consequence of previous exposure to methyl isocyanate or whether it is only the eye that is affected.

Cytogenetic studies in human populations exposed to gas leak at Bhopal, India.

Frequencies of chromosomal abnormalities, sister chromatid exchanges, and replicative index were assessed following peripheral lymphocyte culture in 129 individuals from Bhopal, India. Of these, 83 persons (40 male and 43 female) had been exposed directly to the methyl isocyanate (MIC) gas after the accident at the Union Carbide plant on December 2 and 3, 1984. The remaining 46 samples were taken from age-matched unexposed persons in the same city. Chromosome aberrations were recorded at first cycle metaphase (M1) and sister chromatid exchanges, at second cycle metaphase (M2), following standard schedule. The frequency of chromosomal aberrations was, in general, higher in individuals from the exposed populations, with the females showing a higher incidence. Nondisjunction of chromosomes or laggard was rare. The frequencies of sister chromatid exchanges and depression in mitotic and replicative indices could not be related to exposure or sex. The persistence of chromosomal abnormalities in the form of replicating minutes and exchange configurations, even 1114 days after exposure to the gas, may indicate a residual effect on T-cell precursors.