In the laboratory, this compound may be prepared by treating sodium cyanide with acetone, followed by acidification:[3] Considering the high toxicity of acetone cyanohydrin, a lab scale production has been developed using a microreactor-scale flow chemistry[4] to avoid needing to manufacture and store large quantities of the reagent.

[5] Acetone cyanohydrin is an intermediate en route to methyl methacrylate.

[6] Treatment with sulfuric acid gives the sulfate ester of the methacrylamide,[clarification needed] methanolysis of which gives ammonium bisulfate and methyl methacrylate.

Acetone cyanohydrin is classified as an extremely hazardous substance in the US Emergency Planning and Community Right-to-Know Act and carries an RCRA P069 waste code.

The principal hazards of acetone cyanohydrin arise from its ready decomposition on contact with water, which releases highly toxic hydrogen cyanide.