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ACUTE EXPOSURE INFORMATION

  1. Adiponitrile is a cyanogenic aliphatic nitrile compound. It is irritating to the skin and eyes, and direct dermal contact causes irritation and inflammation. In one case, serious skin destruction on a foot occurred.
  1. The toxicity of adiponitrile is due to metabolic release of cyanide following absorption. A patient who ingested a few milliliters of adiponitrile developed chest tightness, headache, weakness, unsteady gait, vertigo, cyanosis, hypotension, tachycardia, mydriasis, confusion, tonic- clonic muscular contractions, and vomiting, with onset about 20 minutes after ingestion and worsening of the condition about 2 hours later. Treatment with sodium thiosulfate brought about slow recovery.
  1. Rats exposed by inhalation for 10 4-hour periods to adiponitrile concentrations of 0.1 or 0.3 mg/Liter developed salivation, irregular respirations, increased blood glucose, BUN, and creatinine levels, and decreased erythrocyte and leukocyte counts and hemoglobin. These effects had normalized by 14 days following the last exposure, and have not been reported in exposed humans.
  1. In poisoning with most nitrile compounds, the onset of symptoms is generally delayed for up to several hours after exposure, thus making a PROLONGED PERIOD OF OBSERVATION in a CONTROLLED SETTING NECESSARY.
  1. The remainder of this discussion relates to CYANIDE POISONING and TREATMENT. The possibility of DELAYED ONSET of SYMPTOMS, up to SEVERAL HOURS AFTER ADIPONITRILE EXPOSURE must be kept in mind. PROLONGED OBSERVATION is usually required for initially asymptomatic individuals with aliphatic nitrile exposure.
  1. Lesser cyanide exposures may produce nausea, vomiting, palpitations, confusion, hyperventilation, anxiety, and vertigo. Severe hypoxic signs in the absence of cyanosis suggest the diagnosis. Patients have survived potentially lethal cyanide exposures with supportive care only, and the absence of a rapidly deteriorating course does not exclude the diagnosis.
  1. Cyanosis is generally a late finding and does not occur until the stage of circulatory collapse and apnea. Initially the patient may experience flushing, tachycardia, tachypnea, headache, and dizziness. This may progress to agitation, stupor, coma, apnea, generalized convulsions, pulmonary edema, bradycardia, hypotension, and death.
  1. Severe hypoxic signs in the absence of cyanosis should suggest the diagnosis of cyanide poisoning.
  1. If systemic CYANIDE POISONING is suspected, IMMEDIATELY BEGIN ADMINISTERING 100% OXYGEN. OBTAIN THE CYANIDE ANTIDOTE KIT AND PREPARE IT FOR USE.
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