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The binding of cyanide to cytochrome c oxidase prevents transport of electrons from cytochrome c to oxygen. As a result, the electron transport chain is disrupted, meaning that the cell can no longer aerobically produce ATP for energy.
The central nervous system and the heart, are particularly affected. Oral ingestion of a small quantity of solid cyanide or a cyanide solution as little as 200 mg or an airborne cyanide of 270 ppm is sufficient to cause death within minutes. A cherry red skin color may be present as the result of increased venous hemoglobin oxygen saturation.

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