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Lethal dose of hydrogen cyanide is less than 5 mg/kg in gas form The lethal dose for humans in acute poisoning has been reported to be 0.5-3.5 mg HCN/kg body weight (1 mg/kg) Lactate formation 20 mmol/l indicates life-threatening poisoning Serum cyanide determination is not done routinely Cyanide Poisoning Symptoms Shortness of breath, hyperventilation Respiratory failure, respiratory paralysis CNS impairment, confusion Fainting, dizziness Unconsciousness, coma Low blood pressure Circulatory failure Metabolic acidosis Small difference in arterial and venous oxygen saturation ( 80%) Lactatemia Smell of bitter almonds Important to monitor blood gases Metabolic acidosis Treatment of Cyanide Poisoning Immediate decontamination and removal from the source of exposure are critical