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ACUTE EXPOSURE INFORMATION

  1. Malononitrile is a cyanogenic aliphatic nitrile compound, previously used as a treatment for schizophrenia and depression.
    1. When administered to humans intravenously for the treatment of mental illness in doses of 1 to 6 milligrams/kilogram, symptoms of tachycardia, local redness, nausea, vomiting, headaches, shivering and muscle spasms, a sensation of numbness, convulsions, and cardiac collapse were noted.
    1. Restlessness, severe dyspnea, cyanosis, lethargy, tremors, incoordination, and convulsions have been seen in experimental animals administered fatal or near-fatal doses of malononitrile. Oral administration to mice caused gastric mucosal injury.
      1. Pathologic lesions in the spinal ganglia, corpus callosum, and optic nerves and tracts have been seen in rats poisoned with malononitrile, and postulated to be due to tissue anoxia caused by metabolically released cyanide. These effects have not been reported in exposed humans.
  1. The systemic toxicity of malononitrile is due to metabolic release of cyanide by hepatic metabolism following absorption. 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. Malononitrile causes severe eye irritation and has caused irritation of the gastric mucosa in experimental animals following ingestion; it also causes skin irritation, and has caused liver and renal injury in experimental animals. Pulmonary irritation has occurred in mice inhaling malononitrile vapors.
  1. Chronic occupational exposure to other similar nitrile compounds such as acetonitrile has resulted in interference of iodine uptake by the thyroid and some cases of goiter, presumably by interference of thiocyanate produced during normal cyanide detoxification by the endogenous rhodanese enzyme. Whether this occurs with malononitrile exposure is unknown.
  1. The remainder of this discussion relates to CYANIDE POISONING and TREATMENT. The possibility of DELAYED ONSET of SYMPTOMS, up to SEVERAL HOURS AFTER MALONONITRILE 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. 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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