Tinjauan Literatur: Mekanisme Toksisitas dan Temuan Postmortem Sianida dalam Perspektif Forensik:

Abstract

Cyanide is one of the most lethal chemical poisons, inhibiting cytochrome c oxidase in the mitochondrial electron transport chain and causing tissue hypoxia despite adequate oxygen availability. In forensic contexts, identifying the source of exposure and interpreting toxicological findings are essential for determining the cause and manner of death; however, existing studies generally focus on only one aspect. This review aims to explain the mechanisms of cyanide toxicity, routes of exposure, acute and chronic clinical manifestations, postmortem findings, and medicolegal aspects from a forensic perspective. A narrative literature review was conducted by searching PubMed, ScienceDirect, Scopus, and Google Scholar in September–October 2025 using the keywords cyanide, toxicity, cyanide poisoning, forensic, and postmortem findings. Articles published in Indonesian or English between 2015 and 2025 and available in full text were screened in stages, yielding 13 articles from an initial pool of 20. The selected articles were synthesized descriptively and comparatively according to thematic categories. Exposure can occur through inhalation, oral ingestion, dermal absorption, and parenteral routes, with inhalation producing the most rapid onset. Postmortem findings, such as bright red lividity, a bitter almond odor, and organ congestion, are inconsistently reported and nonspecific; therefore, confirmation requires toxicological analysis. Free cyanide rapidly disappears from postmortem samples, whereas the metabolite 2-aminothiazoline-4-carboxylic acid (ATCA) is more stable and may serve as a supportive biomarker. Reported toxic and lethal concentrations vary across sources, and postmortem data on chronic exposure remain very limited. Determining the cause of death due to cyanide poisoning requires the integration of crime scene findings, autopsy results, and toxicological evidence, along with appropriate sample handling. These conclusions are limited by the available literature, which is predominantly composed of case reports.