MCQ – 65868

The Autopsy findings of a case of poisoning caused by inhalation of fumes for a few minutes in a person working in gold mining is represented in the picture below .It will show the following features, except ?  

A.	Characteristic bitter lemon smell.
B.	Congested organs.
C.	Distinct  odor of bitter almonds.
D.	Erosion and hemorrhages in esophagus and stomach.

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Correct Answer � A Explanation

Ans:A.)Characteristic bitter lemon smell.

The poisoning case shown in the picture above represents HCN poisoning as lividity shown is bright red(pinkish red) staining.

HCN poisoning

• Acute hydrogen cyanide poisoning can result from inhalation of fumes from burning polymer products that use nitrile in their production, such as polyurethane, or vinyl.
  • Cyanides are used in many industries and thus are available to potential poisoners.
    • The main industries that use cyanides are:Mining of gold and Silver,Electroplating industry,pesticide industry
• Cyanide poisoning is a form of histotoxic hypoxia because the cells of an organism are unable to create ATP, primarily through the inhibition of the mitochondrial enzyme cytochrome c oxidase.
• Autopsy Findings
  • Hypostasis is said to be brick-red, due to excess oxyhaemoglobin (because the tissue are prevented from using oxygen) and to the presence of cyanmethaemoglobin.
  • There may be a smell of cyanide about the body, and a distinct odor of bitter almonds about the viscera especially in the skull cavity and the brain.
  • Internally the tissues may also be bright pink caused by the oxyhaemoglobin that cannot be utilized by the tissues – which is probably more common than the presence of cyanmethaemoglobin.
  • The stomach lining may be badly damaged and can present a blackened, eroded surface, by altered blood staining the stripped mucosa.The oesophagus may be damage, especially the mucosa of the lower third.

	CO poisoning	Cyanide poisoning
Effect on ability of RBCs to transfer Oxygen	Yes,it impairs	No
Effect on mitochondria	Effect not as much as Cyanide poisoning	Complete and sustained blockade of cellular respiration inducing severe lactic acidosis
Type of Hypoxia	Hypemic hypoxia is caused by the reduction of the oxygen carrying capacity of the blood.	Histotoxic hypoxia because the cells of an organism are unable to create ATP, primarily through the inhibition of the mitochondrial enzyme cytochrome c oxidase.
Amount of exposure required	Requires hours of exposure	Occurs within seconds or minutes of exposure
Post-mortem lividity Colour	Cherry red	Pinkish red
Treatment	Oxygen	Oxygen with Antidote like amyl nitrite,intravenous sodium nitrite, intravenous sodium thiosulfate and Hydroxocobalamin