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Paul Blanc, MD, MSPH; Mary Hogan, RN, MS; Katherine Mallin, PhD; Daniel Hryhorczuk, MD, MPH; Stephen Hessl, MD, MPH; Bruce Bernard, MD

JAMA. 1985;253(3):367-371.

Abstract
Thirty-six former workers in a silver-reclaiming facility who had been exposed over a long-term to excessive levels of cyanide were studied to determine acute and residual toxic reactions. The study involved physical examinations, laboratory studies, and a questionnaire to determine levels of exposure, symptoms during employment, and current symptoms. Questionnaire data showed that during the time of active employment there was a high prevalence of symptoms that are consistent with acute cyanide toxic reactions. A significant positive trend for prevalence of cyanide-related symptoms measured against levels of exposure was demonstrated, supporting a dose-response effect. Some symptoms occurring seven or more months after exposure had ceased also exhibited a dose-response trend. Mild abnormalities of vitamin B₁₂, folate, and thyroid function were detected and suggest long-term cyanide effects.

(JAMA 1985;253:367-371)

Author Affiliations
From the Division of Occupational Medicine, Cook County Hospital (Drs Blanc, Hryhorczuk, Hessl, and Bernard and Ms Hogan), and the Epidemiology and Biometry Program Area, School of Public Health, University of Illinois (Drs Mallin and Hryhorczuk), Chicago.

Footnotes
Reprint requests to Division of Occupational Medicine, Cook County Hospital, Karl Meyer Hall, 720 S Wolcott, Chicago, IL 60612 (Dr Blanc).

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