Which physical findings are characteristic of cyanide toxicity?

Updated: May 30, 2020
  • Author: Inna Leybell, MD; Chief Editor: Michael A Miller, MD  more...
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Physical findings of cyanide exposure are generally nonspecific, yet the onset of illness may be dramatic. Findings can include the following:

  • Vital signs are variable

  • Initial bradycardia and hypertension - May rapidly give way to hypotension with reflex tachycardia, with resulting final bradycardia and hypotension

  • Cardiac dysrhythmias may be followed by cardiac arrest

  • Tachypnea - May be transient, with subsequent bradypnea followed by apnea

  • High, falsely reassuring pulse oximetry - Oxygen is present in the blood as oxyhemoglobin but cannot be effectively used in oxidative phosphorylation

  • Cherry-red skin color - Reflecting absent tissue oxygen extraction

  • Soot in the mouth and nose after smoke inhalation

  • The smell of bitter almonds on the breath (cannot be detected by 60% of the population)

  • Normal or dilated pupils

  • Diaphoresis

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