DETECTION

Some blood agent sensitive chemical agent detectors (e.g., MINICAM, M256A1 sampler-detector) may be used for detection. Commercial cyanogen chloride detectors (e.g., gas monitors, Drager tubes, etc.) are also available.

SYMPTOMS AND EFFECTS

Depending on the degree of intoxication, symptoms may include:

• Elevated lactate levels in combination with low pCO₂ levels.

  Note: carboxyhemoglobin levels are useful in excluding carbon monoxide poisoning in situations where smoke inhalation has occured.

  TOXICITY DATA
  LD50	Route of Administration	in
  100 mg/kg (liquid)	percutaneous	humans
  6 mg/kg	oral	cats
  LCt50	Route of Administration	in
  11,000 mg-m-3/min	inhalation	humans

  ACGIH TLV	0.3 ppm (0.6 mg/m3)
  NIOSH REL	0.3 ppm (0.6 mg/m3)

  MEDICAL COUNTERMEASURES

  Useful Drugs	Amyl nitrite	Sodium nitrite	Sodium thiosulfate

  Be aware that effects of this agent may be delayed, especially if the exposure involved skin contact with the liquid agent. Also note that very high concentrations of vapor or direct contact with liquid are required to produce injury by percutaneous absorption, especially if exposure times are short.

  Remove victims from exposure and decontaminate them as rapidly as possible. Areas with good air flow should be selected for triage/prehospital treatment to allow dissipation of vapor from contaminated individuals. Victims should not be moved into clean treatment areas where unmasked/ungloved personnel are working until decontamination is complete.

  100% oxygen should be given to all victims of exposure, even those with very mild symptoms.

  Inhalation of cyanogen chloride vapors may produce pulmonary edema. This should be treated by administering oxygen. For severe exposure, endotracheal intubation and positive end expiratory pressure (PEEP) ventilation may be appropriate. Other supportive (e.g., bronchodilators and steroids to control bronchospasm) and pallative measures should be employed as needed.

  Pulmonary edema may develop relatively late after exposure, so exposed individuals with indications of respiratory involvement should be observed for at least 24 hours.

  CK liberates cyanide ions, and treatment for exposure to this agent parallels treatment for cyanide intoxication.

  Cyanide is removed by natural metabolic processes, and if exposure is terminated before it has produced lethal levels in the blood the prognosis for recovery is very good, even without antidotal therapy.

  Endotracheal intubation is indicated for victims who have stopped breathing.

  Antidotal therapy for symptomatic victims should be administered as soon as possible.

  1. Administer a methemoglobin forming agent:

  • Sodium nitrite - 300 mg IV (pediatric dose 10 mg/kg) over 5-20 minutes, more slowly if hypotension develops.
    • standard solution is 3%; dose corresponds to 10 mL (pediatric dose 0.33 mL/kg) of standard solution
    • anemic (hemoglobin <12mg/dL) victims should receive smaller quantities
    • use with caution if victim suffers from smoke inhalation
  or
  • Amyl nitrite - one 0.2 mL ampul inhaled over 0.5-1 minutes
    • this should be used only when it would be impossible to administer intravenous sodium nitrite
  2. Administer a sulfur donor to promote conversion of cyanide to thiocyanate:
  • Sodium thiosulfate - 12.5 g IV (pediatric dose 0.41 g/kg) over 10 minutes.
    • standard solution is 25%; dose corresponds to 50 mL (pediatric dose 1.65 mL/kg) of standard solution
    • may be used alone, especially if victim also suffers from carbon monoxide poisoning (e.g., due to smoke inhalation)
  If needed, the treatments may be repeated one time at half the orignal dose.

  Sodium bicarbonate should be used to control acidosis in severe poisoning.

  An anticonvulsant such as lorazepam (adult 4 mg, pediatric dose 0.1 mg/kg IV or IM in 2-5 minutes, repeat as needed) may be useful in controlling seizures.

  PHYSICAL COUNTERMEASURES

  Initial Isolation and Protective Action Distances
  SMALL RELEASE (small package/leaking container)
  First ISOLATE in all directions	Then PROTECT persons downwind during
  	DAY	NIGHT
  60 m (200 ft)	0.6 km (0.4 mi)	2.4 km (1.5 mi)
  LARGE RELEASE (large package/multiple small packages)
  First ISOLATE in all directions	Then PROTECT persons downwind during
  	DAY	NIGHT
  400 m (1300 ft)	4.0 km (2.5 mi)	8.0 km (5.0 mi)

  When dealing with victims who have not been decontaminated protective equipment including self-contained breathing equipment or gas masks should be used. Medical personnel treating contaminated victims should avoid direct (skin-to-skin) contact. Latex gloves are not adequate protection. Chemical protective gloves should be used. Casualties should be decontaminated as rapidly as possible (see the section on decontamination). Remove casualties from exposure as rapidly as possible. Casualties must not be moved into clean treatment areas where unmasked/ungloved personnel are working until decontamination is complete.

  Also refer to 2000 Emergency Response Guidebook (ERG2000) Guide 125.

  DECONTAMINATION

  Victims

  Decontamination of victims is accomplished by removing the victim from the contaminated area, removal of clothing, and removal of any agent present on the skin. Agent on the skin should be promptly removed by blotting followed by rinsing with copious amounts of soap and water. In the absence of liquid agent residues, victims should be washed with copious amounts of water or soap and water for at least 2-3 minutes. Ambulatory victims and exposed individuals should shower.

  Property

  Clothing should be washed thoroughly.

  Urgent decontamination can be accomplished using soap and water, collecting the run-off. Cyanogen chloride is nonpersistent, and decontamination may be accomplished by allowing sufficient time for the agent to evaporate while monitoring vapor concentrations and restricting access to avoid producing a hazardous situation.

  Cyanogen chloride is soluble in water, but hydrolysis is slow.

  COMMON PRECURSORS

  • Chlorine
  • Mercury cyanide
  • Potassium cyanide
  • Sodium cyanide

  COMMENTS

  Cyanogen chloride may be produced when using bleach-containing decontaminants for decomposition of the nerve agent GA

  Cyanogen chloride is a moderately important industrial chemical, with uses in synthesis, including the synthesis of herbicides, ore refining, and as a metal cleaner. One of its more interesting uses is as a warning agent in fumigants, where its ability to irritate at low concentrations is used to alerts workers to the presence of hazardous materials that are less noticible.

  Because of its industrial utility, cyanogen chloride is a schedule 3(A) chemical under the Chemical Weapons Convention, meaning that it can be produced in large quantities provided that it is not produced for use as a weapon.

  Historical Notes

  Cyanogen chloride's first reported synthesis was in 1802 by the French chemist Comte Claude Louis Berthollet.

  Like hydrogen cyanide, cyanogen chloride was used during World War I beginning in July of 1916. Also like hydrogen cyanide, it was used almost exclusively by the French, who called it Mauguinite. The British also noted it, assigning the code CC to the agent (this code was later changed to the now-standard CK). (The Germans decided to try a related compound, cyanogen bromide.)

  The French also produced a mixture they named Vitrite and designated as 4B. Vitrite consisted of 70% cyanogen chloride with 30% arsenic trichloride, with the arsenic trichloride serving as a stabilizer to prevent the formation of the trimer.

  Cyanogen chloride attracted interest due to its similarity in its toxic effects to hydrogen cyanide along with its irritating effects combined with a hope that its greater vapor density would make it a more effective agent. The agent also tended to break down the chemicals used to provide protection in the masks of the time, a quality seen as desirable. Finally, the fact that it didn't burn up when the burster charge in a shell was seen as giving it a decided edge over hydrogen cyanide. However, its use was never widespread.

  The "mask breaking" properties of cyanogen chloride (which were aided by a humid environment) would lead to a resurgence in interest in the agent during World War II, when the Americans would decide that it might be useful against the Japanese (whose gas masks lacked the impregnants that would provide protection against the mask breaking action of CK). More than 11,000 tons were produced, but in the event chemical agents were not used by the United States in this conflict.

  After World War II, cyanogen chloride rapidly fell out of the first line (and even the second line) of chemical weapons stockpiles, replaced in the favor of military chemical warfare by the fast acting nerve agents. Nevertheless, it may still sometimes be stockpiled for use as a weapon, in part because of the ease with which it can be manufactured and often in situations where its dual use status as an industrial chemical and a military agent helps to obfuscate the purpose of the stockpile.

  Terrorists and Cyanogen Chloride

  al Qaeda

  It has been reported that the al Qaeda terrorist group has produced and developed plans for the employment of chemical weapons, including cyanogen chloride.

  • Osama bin Laden has stated that Al Qaeda has a chemical capability ("I wish to declare that if America used chemical and nuclear weapons against us, then we may retort with chemical and nuclear weapons. We have the weapons as a deterrent." - interview with Hamid Mir for Dawn), but has not specified the agents.

  Related International Classification of Diseases Codes

  Heading	ICD-9-CM
  Toxic effect of other specified gases and vapors	987.7
  Toxic effect of unspecified gases, fumes, or vapors	987.9
  Accidental poisoning by other specified gases and vapors	E869.8
  Accidental poisoning by unspecified gases and vapors	E869.9
  Suicide and self-inflicted poisoning using other specified gases and vapors	E952.8
  Suicide and self-inflicted poisoning using unspecified gases and vapors	E952.8
  Assault by poisoning using other solid and liquid substances	E962.1
  Assault by poisoning using other gases and vapors	E962.2
  Injury due to war operations by gases, fumes, and chemicals	E997.2
  Late effect of injury due to war operations	E999
  Heading	ICD-10
  Accidental poisoning by and exposure to other and unspecified chemicals and noxious substances	X49
  Intentional self-poisoning (suicide) by and exposure to other gases and vapors	X67
  Assault (homicide) by gases and vapors	X88
  Assault (homicide) by other specified chemicals and noxious substances	X89
  Assault (homicide) by unspecified chemical or noxious substance	X90
  War operations involving chemical weapons and other forms of unconventional warfare	Y36.7

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