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Cyanide is a potent poison that has been recognized as a weapon since antiquity. As an open-air battlefield weapon, its use has been limited, but cyanide is a potent terrorist weapon when delivered under the right circumstances. Terrorists have used cyanide in the past and are likely to use this weapon again in the future.
A pediatrician should be able to recognize victims of cyanide poisoning and to initiate treatment. Cyanide poisoning can resemble poisoning by other chemical weapons, including nerve agents, and it can be lethal in minutes; however, an effective treatment exists and is widely available.
Cyanide, its salts, and related compounds are present in natural and synthetic processes. They are essential to many industries, and numerous compounds liberate cyanide during combustion or metabolism. While cyanide is ubiquitous, it is an uncommon cause of poisoning in children.
In the United States, only 8% of cyanide poisonings reported in 2000 occurred in children younger than age 19.1 In commercial and house fires, cyanide can be liberated during combustion, and it can act synergistically with carbon monoxide to cause fatalities. As military weapons, the key compounds of interest are volatile liquid hydrogen cyanide and cyanogen chloride.
Cyanide was first considered as a battlefield weapon in the Franco-Prussian War, but its derivatives were first deployed during World War I. However, it was not an effective battlefield weapon. At the concentrations created by the delivery systems used, cyanogen chloride and cyanogen bromide primarily caused upper airway and mucus membrane irritation. There were also significant problems with storage and transportation.
Cyanide compounds were more effective as indoor poisons. In World War II, the Nazis used hydrocyanic acid (Zyklon B) to murder millions in death chambers. In the 1980s, Syria and Iraq both allegedly used cyanide-based weapons.
While cyanide is a relatively ineffective poison for outdoor use, its indoor lethality makes it an attractive weapon of terror. When ingested in food or water, it can also be lethal. In 1995, cyanide allegedly was deployed as a terrorist weapon in the Tokyo subway (weeks after the Tokyo subway sarin attack). In this crude but functional attempt, a cyanide salt was allowed to mix slowly with an acid to create volatile hydrocyanic acid.2 The apparatus was constructed with household bags and...