Kalium cyanatum

An inorganic salt (KCN) of formidable toxicity; in crude form it arrests cellular respiration by paralysing the cytochrome oxidase system, producing fulminant tissue asphyxia with sudden syncope, convulsions, respiratory arrest, and deep cyanosis—features that blueprint its homœopathic picture of constrictive dyspnœa, collapse and spasmodic phenomena [Hughes], [Allen]. The odour of bitter almonds is noted in toxicology; the blood remains bright from impaired oxygen utilisation; pupils dilate; pulse fails; breathing becomes gasping and irregular (Cheyne–Stokes–like) before silence [Hughes], [Allen]. In pharmacy it is triturated from the pure salt and potentised. Clinical experience rapidly focussed its sphere upon malignant throat and laryngeal states with impending suffocation, angina-like constriction of the chest, sudden collapse, epileptiform and tetanic seizures, and a striking prosopalgia (infraorbital neuralgia), commonly right-sided, with violent stabbing pains [Clarke], [Hering], [Boericke]. The keynote polarity is constriction–asphyxia with cold, blue, clammy collapse and a constant craving for air, fanning and head-elevation [Clarke], [Hughes].

Knowledge stems chiefly from [Toxicology] and clinical observations compiled by Allen and Hering, with bedside confirmations in diphtheritic and laryngeal crises, angina pectoris with suffocative constriction, infraorbital neuralgia, epileptiform convulsions, and sudden collapse; modalities—worse warmth of room or bed, exertion, swallowing and lying down; better cool air, fanning, head high, absolute rest [Allen], [Hering], [Clarke], [Boericke], [Farrington], [Phatak].

Kali-cy. is the image of constriction with asphyxia and sudden collapse—a salt that arrests life by shutting the cell’s door to oxygen, mirrored clinically by a patient who feels gripped at throat and chest, gasps irregularly, grows blue and clammy, and fears he will die for want of air. The essence is a polarity: spasm (laryngeal clutch, chest band, infraorbital stabbing, convulsions) alternating with paralysis (aphonia, failure of breathing, faint pulse), set in a thermal and atmospheric field of worse warmth and closed rooms, better cool air, fanning and elevation of the head. The mental state is focused, concrete fear—of choking, of the heart stopping—without the restless fuss of Arsenicum or the febrile tumult of Aconite; he is often very quiet because motion aggravates and the least exertion brings syncope [Clarke], [Allen]. The cardiac element is strong: an anginoid precordial clutch radiating down the left arm with numb hand, anxiety, and cold sweat, meeting Farrington’s chest constriction profile while remaining distinct from Cactus by its cyanotic collapse and intolerance of heat [Farrington], [Clarke].

The laryngo-throat field is equally marked. In malignant throat states the membrane is dark and the prostration early and deep; yet the characteristic desire is for cold sips and cool air, not warmth—pointing away from Hepar and towards Kali-cy. when aphonia, head-high necessity, and choking on the least swallow lead the totality [Clarke], [Boericke]. The neuralgic keynote—a stabbing infraorbital pain (often right) with cold sweat and night aggravation—adds a mineral sharpness to the picture and, when present with suffocative concomitants, clinches the choice [Clarke]. In management, align the regimen to the remedy: cool, quiet room; window open; collar loose; head high; forbidding stimulants and warm drinks; small cold sips allowed. Potencies may be lower and frequent (3X–6X) in frank collapse, or higher (30C–200C) to control neuralgic–anginoid paroxysms in recurrent sufferers; repetition follows the crisis curve—close during gasping phases, spacing as respiration and pulse steadies [Dewey], [Boericke], [Phatak]. Recognise it when the case is compressed into a few minutes: a blue, cold patient, eyes wide, whispering “Air—air,” clutching at throat and heart, who can be brought back by cool currents and the similimum.

Respiration / Nervous centres

• Respiratory centre and medulla—irregular, gasping respiration, impending arrest; Cheyne–Stokes tendencies; urgent air-hunger. [Hughes], [Allen], [Clarke]

• Sleep–breath axis—cannot lie down; sits up for air; starts with choking; dreams of drowning. [Hering], [Clarke]

Larynx / Throat

• Larynx and glottis—spasm, oedematous narrowing, aphonia; cannot bear the throat covered; dread of suffocation. [Hering], [Boericke]

• Throat and fauces—dark, malignant membranes, dysphagia, choking on least swallow; rapid asthenia. [Clarke], [Boericke]

Heart / Circulation

• Heart and vasomotor system—anginoid constriction, precordial anxiety, feeble or intermittent pulse, syncope on effort. [Clarke], [Farrington]

• Blood and tissues—tissue anoxia with lividity and cold clammy sweat; sudden failure of reaction. [Hughes], [Boger]

Face / Head / Nerves

• Cranial nerves (infraorbital branch)—stabbing, lightning neuralgia, often right side; paroxysmal, with livid face and cold sweat. [Clarke], [Allen]

Extremities / Motor sphere

• Peripheral motor apparatus—clonic convulsions, trismus, tetanic bends; then prostration; alternation of spasm and paralysis. [Allen], [Hering]

Stomach

• Sudden sinking, nausea, violent retching with coldness; intolerance of warm drinks. [Allen]

Extreme anxiety with air-hunger; fear of immediate death by suffocation; begs for air and to have windows opened, which tallies with the amelioration from cool air already noted [Clarke], [Allen]. Thoughts fix upon the heart and the throat; a hand to the neck or sternum signals the sense of a band or clutch. Restlessness alternates with sudden stupor as the blood grows unserviceable; he may be surprisingly quiet, with a deadly calm between gasps, then spring to clutch for air [Hughes], [Hering]. Speech is low, hurried or lost; he answers in whispers; the least talking renews dyspnœa (Mind ↔ Respiration/Throat). Terror of being left alone is common, yet the presence of many people or fuss increases oppression; gentle steady company reassures. In neuralgic paroxysms the temper is irritable and intolerant of touch; pressure he craves and will press the cheek into the pillow (Mind ↔ Face). A sense of impending catastrophe—“something will stop”—heralds syncope or a convulsion; afterwards he is apathetic, as if stunned. Children in laryngeal spasm grasp the mother and cannot bear to be laid flat; they are icy, blue, with dilated pupils and cold sweat (mini-case vignette) [Hering], [Clarke].

Sleep is unsafe: he starts with a choke, clutches the throat, and must sit up for air, which tallies with the Better For (head high, air) already noted [Hering], [Clarke]. Cannot lie flat; dozes propped, sliding into gasps. First sleep after midnight broken by suffocative dreams; towards morning short snatches come as the circulation steadies. Children sleep with mouth open and head thrown back; any covering of the neck wakens choking.

Frightful dreams of drowning, strangling, being buried alive; of rooms without windows; of the heart stopping (Dreams ↔ Respiration/Heart) [Clarke]. On waking he is breathless and blue, with a sense of impending death that subsides with cool air and fanning.

Kali-cy. epitomises constriction with asphyxia and sudden collapse: choking at the throat, iron band round chest, precordial clutch, gasping, irregular respiration tending to arrest; pulse small and failing; livid, cold, clammy sweat; pupils dilated; mind obsessed with air and fear of immediate death [Allen], [Clarke], [Hughes]. The master modalities—worse warmth, effort, speaking, swallowing, lying flat; better cool air, fanning, head raised, absolute rest, cold sips—recur in Mind, Throat, Chest, Heart, Respiration and Sleep. Its neuralgic side (infraorbital stabbing, often right) supplies a striking concomitant to the suffocative states (Face/Head). Alternation of spasm and paresis, and of panic and stupor, betrays its medullary hold. Differentiate from Lauro. and Hydrocy-ac. (both prussic; more pure convulsive or paralytic pictures; Kali-cy. adds anginoid constriction and cardiac failure with strong air craving), from Cactus (constriction without cyanotic collapse to the same degree), Carbo-v. (air hunger with collapse but asks for fanning when icy and flatulent rather than choking at the throat), and Naja (angina with left-ward radiation and moral depression rather than gasping panic). Direction-of-cure is outward and upward: as the patient can be laid a little flatter with free air hunger abating, and as cold sips are tolerated without choking, the heart steadies and the pulse fills.

Fever is not the type; the picture is rather of collapse with coldness and sweat, yet internal burning in chest or epigastrium may be lamented [Allen], [Clarke]. Pulse small; face livid; thirst for cold sips. In malignant throat states a low, adynamic fever accompanies dark membranes; the suffocative element dominates.

Chill with cold, blue skin; cannot warm; heat of room is intolerable, increases oppression (Chill/Heat ↔ Respiration) [Clarke]. Sweat cold, clammy, bead-like on forehead; comes with faintness and does not relieve unless air is given.

Vertigo on the least attempt to rise; a blackness before the eyes; he must sit at once or will fall—orthostatic failure (Head ↔ Heart) [Allen]. Pressing constriction mounts from sternum to throat and temples; a steel band round the head in anginoid moments; warmth of the room increases the throbbing; cool air allays it. Supraorbital and infraorbital neuralgia—paroxysmal, stabbing, often distinctly right-sided; better hard pressure and cold; worse at night and warmth (Head ↔ Face/Modalities) [Clarke]. Occiput heavy in collapse; hairline profusely damp with cold sweat. After convulsions, dull ache, confusion and soreness of scalp.

Pupils widely dilated during attacks; eyes fixed, glassy; lids half open in syncope [Hughes], [Allen]. Dark circles appear rapidly with cyanosis; conjunctivæ injected or dark; vision dims with each gasp and clears slightly with fanning (Eyes ↔ Respiration). Sparks or floating specks before eyes during precordial anxiety; cannot tolerate glare or warm rooms. In neuralgic cases, tearing pains shoot into the orbit with lachrymation; pressure relieves.

Ringing in the ears precedes fainting; sudden noises startle and precipitate palpitation or a spasm (Ears ↔ Heart/Mind) [Hering]. Hearing dull during cyanotic spells; better in cool air; earache is rare, but infraorbital pains may radiate to the ear.

Nose icy cold and blue; cold breath; alæ nasi flare widely in the struggle for air [Clarke]. Smell subjective of smoke or bitter almonds is noted in toxicology; in practice the room has the cold, damp odour of collapse rather than putridity (contrast Merc. or Bapt.). Epistaxis is uncommon, but a thin watery discharge may appear with laryngeal spasm.

Face livid, leaden or ashy; lips blue; expression of anguish and air-hunger [Clarke], [Allen]. Prosopalgia: lightning-like stabbing along the infraorbital nerve, chiefly right, with twitchings of the facial muscles and cold sweat; better pressure, worse warmth of room and after midnight (Face ↔ Head/Modalities) [Clarke]. Trismus occurs in severe spasmodic attacks; the jaw clenches before a convulsion. Cheeks collapse and feel cold as marble to the attendant’s hand (clinical image) [Hering].

Speech fails; aphonia or only a whisper; tongue pale, cold; saliva frothy; breath cool [Allen], [Clarke]. Swallowing small sips of cold water is possible and relieving; warm drinks excite gagging and spasm (Mouth ↔ Throat/Stomach). Taste absent during collapse; after attacks there is an acrid, metallic taste. Teeth feel too long during facial neuralgia; he clenches them to oppose the throbs.

Neuralgic radiations into upper molars on the right; pressing the teeth together or biting on a cloth steadies the pain (Teeth ↔ Face) [Clarke]. Dental procedures or draughts of warm air may trigger prosopalgic paroxysms; cold applications soothe. No specific carious or gingival picture.

Fauces feel grasped; choking on the least swallow; fluids may return by the nose from spasm or palatal paresis [Hering], [Clarke]. Voice husky, then gone; attempts to speak or swallow renew dyspnœa—this tallies with the Worse For (swallowing, talking) already noted. In malignant throat states the membrane is dark, the prostration great, and the suffocative feeling out of proportion to visible swelling; the craving is for cold sips and cool air, not warmth (contrast Hepar or Lac-c.) [Clarke], [Boericke]. Cannot endure anything about the neck; children tear at the collar.

Crushing constriction as by an iron band round chest; must sit up and lean forward; the least movement renews the clutch (Chest ↔ Modalities) [Clarke], [Farrington]. Sternum and precordium feel pressed by a hand; pains may dart to the left shoulder/arm (anginoid), with numb fingers and deadly anxiety. Rattling is slight; chest sounds are often poor—failure is central, not bronchial. A short, dry, suffocative cough may precede a choking spell; warm rooms excite it; cool air abates it.

Precordial anxiety with a sense that the heart will stop; pulse small, quick—or intermittent, feeble, lost at the wrist in collapse [Clarke], [Allen]. Palpitation on the least exertion or emotion; cannot talk without flutter; hand to the heart. Angina pectoris picture: constriction, extension to left arm, numb hand, terror and cold sweat; better stillness, air, head high; worse warmth, effort (Heart ↔ Chest/Generalities) [Farrington], [Clarke].

Irregular, gasping; long pauses; then hurried catching up—Cheyne–Stokes modifications observed in toxicology and mirrored clinically [Hughes], [Allen]. Laryngeal spasm in paroxysms; cannot bear the throat touched or covered; voice gone to a whisper. Wants fanning; begs for window open; lying down is impossible (Respiration ↔ Modalities). Sighing respiration occurs between gasps as if to stave off collapse.

Sudden sinking at epigastrium as if life would cease; nausea with ineffectual retching; coldness at the pit; faintness follows if he attempts warm drinks [Allen], [Clarke]. Vomiting may occur with a convulsive paroxysm; afterwards extreme emptiness, trembling and thirst for cold water in small quantities (Food & Drink). Pressure over the epigastrium is intolerable during anginoid pains; eructations give slight relief.

A fluttering in epigastrium precedes palpitation; a tight band seems to pass round the upper abdomen with the chest constriction (Abdomen ↔ Heart/Chest). Colic is rare; bowels tend to be still during crises. In collapse, abdomen is cold to touch; borborygmi absent; the patient dreads motion.

In extreme attacks involuntary stool with syncope may occur; otherwise constipation from fear of straining and effort. Tenesmus is absent. After recovery, a soft stool relieves the head.

Scanty, high-coloured urine during spells; may be temporarily suppressed in profound collapse [Allen]. Urging absent; after an attack a free flow gives a sense of relief and warmth (Urinary ↔ Generalities). Albumin not characteristic; the keynote is scanty from circulatory failure.

Aversion to warm drinks; they aggravate nausea and choking; desire for cold water in small sips; ice calms throat and stomach (Food ↔ Throat/Stomach) [Allen], [Clarke]. Appetite suspended; the least attempt to eat brings faintness; after attacks he craves a little cold milk. Alcohol and coffee aggravate palpitation.

Sexual sphere is depressed in chronic sufferers with angina tendency; emissions rare; impotence from cardiac fear is noted (Male ↔ Heart). Genital neuralgia is not marked; cold sweat after slight excitement.

Spells cluster about the menses in some subjects; suffocative constriction and facial neuralgia worsen premenstrually and in warm rooms (Female ↔ Face/Heart) [Phatak]. Puerperal convulsions with cold, blue collapse may call for Kali-cy. when air-hunger and head-high necessity dominate (clinical note) [Hering].

Coldness down the back; chill between scapulæ preceding choking; aching in lower dorsal region after attacks [Clarke]. Spine rigid during convulsions; the nape is stiff and sore. Warm applications to the back aggravate breathlessness; cool sponging refreshes.

Fingers bluish; nails livid; hands and feet cold and damp [Clarke], [Allen]. Trembling; clonic spasms; thumbs drawn into palms in severe seizures; then great prostration. Cramps in calves during anginoid oppression; feet numb and tingling after an attack. Cannot bear to walk across the room; staggering gait with blackness before eyes.

Ashen or livid with cold, clammy sweat—“corpse sweat” while yet alive; surface cold even near the heart [Hering], [Clarke]. Mottling of extremities; cyanosis of lips and nails. Eruptions are not typical; rather an absence of reactive skin phenomena in the collapsed state (contrast Ars., Bapt.).

Aetiology / Asphyxial collapse

• Hydrocy-ac.: prussic acid picture—sudden convulsions, coma; less chest “band” and prosopalgia; Kali-cy. shows anginoid precordial clutch with urgent air-craving. [Allen], [Clarke]

• Laurocerasus: asphyxial states with sopor, rattling; more passive cyanosis, less stabbing neuralgia; desires air but is drowsy. [Hering], [Clarke]

• Carbo veg.: collapse, wants to be fanned, cold, flatulent; less throat-clutch constriction; more abdominal tympany. [Kent], [Clarke]

Chest / Angina

• Cactus grand.: constriction “iron band,” periodic; less sudden syncope/air-hunger; warmer patient. [Farrington]

• Naja: angina with left arm pains, moral depression, valvular lesions; less choking at throat and warm-room intolerance. [Clarke]

• Glonoinum: throbbing, bursting head; vasodilatory rush; not the cold, livid, gasping collapse of Kali-cy. [Kent]

Throat / Larynx

• Hepar: croupy, very chilly, exquisite touchiness; wants warmth; Kali-cy. is worse warmth and craves cool air, with aphonia and choking. [Hering], [Clarke]

• Kali-bi.: adhesive ropy exudate, boring root-of-nose pain; less collapse; more stringy expectoration. [Farrington]

• Merc-cyanatus: malignant diphtheria with putrid fetor and glandular swelling; Kali-cy. has extreme air-hunger and cold, blue collapse. [Clarke]

Collapse / Syncope

• Camphor: icy-cold collapse without deep cyanosis; great shrinking from touch; less chest-band; often odour of camphor. [Hughes], [Allen]

• Veratrum alb.: collapse with cold sweat and vomiting/diarrhœa; less choking-at-throat, more gastro-intestinal storm. [Nash]

Neuralgia

• Spigelia: left-sided, clock-like periodicity, eye pains; Kali-cy. often right infraorbital, with cold sweat and suffocative concomitants. [Clarke]

• Aconite: neuralgia after cold wind with intense fear; lacks cyanotic collapse; anxiety more febrile. [Kent]

• Complementary: Carbo veg. — both collapse and air-hunger; Kali-cy. in choking, cyanotic, anginoid states; Carbo-v. to sustain reaction when flatulent coldness predominates. [Clarke], [Kent]

• Complementary: Cactus grand. — angina with band-like constriction; Kali-cy. in acute suffocative crises; Cact. to regulate chronic constriction. [Farrington]

• Complementary: Laurocerasus — deep asphyxial states with sopor; follows when spasm subsides into paralytic breathing. [Hering], [Clarke]

• Follows well: Aconite — after initial shock/fear; Acon. calms panic, Kali-cy. meets the choking collapse. [Kent], [Dewey]

• Follows well: Spigelia — when neuralgia shifts to suffocative anginoid crises. [Clarke]

• Precedes well: Digitalis — if cardiac weakness with intermittent pulse persists after suffocative phases abate. [Farrington]

• Related — Hydrocy-ac., Lauro., Cact., Naja, Carbo-v., Camph., Verat-a., Spig., Hepar, Kali-bi., Merc-cyan. (see differentials). [Clarke], [Boericke]

• Antidotes (pragmatic) — cool air, head-high posture, loosening clothing; medicinally, Amyl-nit. has been used palliatively in anginoid spasm (clinical). [Hughes], [Clarke]

• Inimicals — none fixed; avoid frequent alternation with other prussic remedies without fresh indication. [Kent]

• Anginoid paroxysms — iron band round chest with radiation to left arm, cold sweat, worse warmth or motion, better cool air and head high; Kali-cy. often relieves when Cactus leaves cyanosis and air-hunger unabated. [Farrington], [Clarke]

• Laryngeal spasm/aphonia — in dark, malignant throat states; chokes on the least swallow; wants cold sips; cannot bear the neck covered; room must be cool. [Clarke], [Boericke]

• Prosopalgia (infraorbital, right) — stabbing, paroxysmal neuralgia, better firm pressure or cold, worse at night or in warm room—especially when joined with air-hunger or palpitations. [Clarke]

• Collapse with Cheyne–Stokes breathing — icy, blue, clammy; pupils dilated; wants to be fanned; prescribe in low potency, repeated frequently, with room cooled and head elevated. [Allen], [Hughes]

Mind

• Anxiety — suffocation, begs for air; better fanning or open window. A key bedside pointer. [Clarke], [Allen]

• Fear of death — from choking; sits still, does not move lest it worsen—distinct from the restless fuss of Arsenicum. [Kent], [Clarke]

• Aversion to being alone — but fuss aggravates; gentle, quiet company soothes. [Clarke]

• Speech — whispering only; talking aggravates dyspnœa—economy of words. [Allen]

• Startled by noise — palpitation and choking follow; noise as precipitant. [Hering]

Head / Face

• Vertigo — on rising; blackness before eyes; must sit at once—orthostatic failure. [Allen]

• Neuralgia — infraorbital, right side; stabbing, paroxysmal; pressure amel., warmth agg.; distinguishes from Spigelia. [Clarke]

• Head — band-like constriction with angina; “iron circlet”; better air, worse warmth. [Clarke], [Farrington]

• Face — livid; lips blue; cold sweat—classic collapse sign. [Clarke]

Throat

• Choking — on the least swallow; liquids regurgitate through nose; cannot bear throat touched or covered. [Hering], [Clarke]

• Aphonia — voice only a whisper; laryngeal paresis or spasm. [Boericke]

• Diphtheritic membranes — dark, malignant; great prostration; thirst for cold drinks. [Clarke]

• Modalities — worse warm room; better cold sips, cool air—clear thermal polarity. [Allen]

Chest / Heart / Respiration

• Constriction — chest bound as with iron band; must sit up; motion agg.; cool air amel.—core rubric. [Clarke], [Farrington]

• Angina pectoris — pain radiates to left arm with numbness of hand; cold sweat; Kali-cy. hallmark. [Clarke]

• Respiration — irregular, gasping, Cheyne–Stokes tendency; failing centre. [Hughes], [Allen]

• Orthopnœa — cannot lie down; head high position amel. [Boericke]

• Palpitation — on least effort or speaking; intermittent, weak pulse—failure motif. [Allen]

• Air-hunger — begs to be fanned, window open; instant relief. [Clarke]

Stomach / Abdomen

• Epigastric sinking — as if life would cease; warm drinks agg.; cold sips amel. [Allen]

• Nausea — with convulsive retching; accompanies air-hunger. [Allen]

• Band-like tightness — round epigastrium with chest constriction; unity of symptom. [Clarke]

• Pressure — epigastrium intolerable during paroxysm. [Clarke]

Extremities / Skin / Generalities

• Convulsions — clonic; thumbs drawn into palms; collapse follows spasm; alternation of spasm and paralysis. [Allen], [Hering]

• Cyanosis — lips and nails blue; cold, clammy sweat—collapse hallmark. [Clarke]

• Modalities — worse warmth, effort, lying flat; better cool air, fanning, head high, absolute rest. [Clarke], [Kent]

• Weakness — walking across room impossible; blackness before eyes; syncope risk. [Allen]

• Nails — blue; hands icy—objective observer’s sign. [Clarke]

• Suppressed reaction — no rash appears; skin stays pale or blue; adynamic states. [Boger]

Allen, T. F. — Encyclopædia of Pure Materia Medica (1874–1879): toxicology of potassium cyanide; collapse, convulsions, respiratory arrest; chest constriction; modalities.
Hering, C. — The Guiding Symptoms of Our Materia Medica (1879–1891): clinical confirmations—laryngeal spasm, aphonia, choking on swallowing, collapse states; child vignettes.
Clarke, J. H. — A Dictionary of Practical Materia Medica (1900): remedy portrait—anginoid constriction, infraorbital neuralgia (right), cool-air amelioration; differentials.
Hughes, R. — A Manual of Pharmacodynamics (late 19th c.): cyanide pharmacology; medullary and cardiac effects; Cheyne–Stokes notes.
Boericke, W. — Pocket Manual of Homœopathic Materia Medica (1901): keynotes—air-hunger, worse warmth, better cool air/head high; throat and angina indications.
Boger, C. M. — Synoptic Key of the Materia Medica (1915): generalities—collapse, cyanosis, spasm–paralysis alternation; repertorial pivots.
Kent, J. T. — Lectures on Homœopathic Materia Medica (1905): miasmatic colourings; comparisons with Carbo-v., Lauro., Cact.; management principles.
Farrington, E. A. — Clinical Materia Medica (1890): chest constriction/angina comparisons; placement among cardiac remedies.
Phatak, S. R. — Materia Medica of Homoeopathic Medicines (20th c.): condensed keynotes—air-hunger, modalities; menstrual aggravation notes.
Nash, E. B. — Leaders in Homœopathic Therapeutics (1899): collapse therapeutics; contrasts with Verat-a., Camph., Acon.
Dewey, W. A. — Practical Homœopathic Therapeutics (early 20th c.): dosing/repetition in collapse; bedside regimen—cool air, head elevation.
Lippe, A. von — Keynotes and Characteristics (late 19th c.): sharp keynotes—cyanosis, suffocation, clutching at throat; prosopalgia pointer.