

As poisoning progresses, hemodynamic status may become unstable. Early respiratory signs include transient rapid and deep respirations.

Skin may look normal or slightly ashen, and arterial oxygen saturation may be normal. As hypoxia progresses, progressively lower levels of consciousness, seizures, and coma can occur. Early manifestations include anxiety, headache, giddiness, inability to focus the eyes, and mydriasis. Signs and symptoms of cyanide poisoning usually occur less than 1 minute after inhalation and within a few minutes after ingestion. Cyanide causes intracellular hypoxia by reversibly binding to mitochondrial cytochrome oxidase a 3.
