The origin of hydrogen cyanide in breath.

The excretion of hydrogen cyanide in breath and blood concentrations of cyanide were measured in eight normal subjects. There was no correlation between breath and blood levels of cyanide. Furthermore, breath cyanide concentrations calculated from blood values were much lower than measured values, which suggested a local production of hydrogen cyanide in the oropharynx. When saliva was incubated at 37 degrees C hydrogen cyanide was formed in the presence of air but not in a nitrogen atmosphere. No hydrogen cyanide was formed with boiled saliva and the production of hydrogen cyanide by native saliva was inhibited by catalase and by 6-n-propyl-thiouracil. Centrifugation of saliva resulted in a supernatant and a sediment, which were both required for the formation of hydrogen cyanide. Dialysis of the supernatant abolished its cyanide forming ability, which could be restored by addition of thiocyanate. We conclude that most of the hydrogen cyanide found in breath from normal human beings originates from oxidation of thiocyanate by salivary peroxidase in the oropharynx. As a consequence measurements of breath hydrogen cyanide can only be used to detect heavy exposure to cyanide.