12/28/2023 0 Comments Cyanide antidote![]() Iatrogenic cyanide poisoning via excessive or prolonged nitroprusside infusion has also been described. Combustion of materials such as wool, silk, synthetic rubber, and polyurethane generates cyanide as a by-product and can lead to poisoning via inhalation during structure fires. Cyanogenic glycosides such as amygdalin are found within plants of the Manihot spp (cassava), Linum spp, Lotus spp, Prunus spp (apricots, bitter almond, cherry, peaches), Sorghum spp, and Phaseolus spp. Organic cyanide compounds are called nitriles and are commonly found in glues, nail polish removers, rubber compounds, and latex free medical gloves. Inorganic cyanide salts such as sodium cyanide and potassium cyanide are industrial reagents used in metallurgy, photographic developing, plastic manufacturing, jewelry polishing, and chemical synthesis. While acute cyanide poisoning is rare, this is still likely a significant underestimate of the number of true cases given the severity of toxicity and high likelihood of rapid death that would preclude poison control centers being contacted. In 2020 there were 247 cases and 4 deaths associated with acute cyanide poisoning that were reported to the National Poison Data System. Cyanide gas was widely used as a chemical warfare agent in World War I, and as an agent of genocide in the form of hydrocyanic acid pellets (Zyklon B) in Nazi concentration camp gas chambers during World War II. Hydrogen cyanide was first isolated in 1782 by Swedish chemist Carl Wilhelm Scheele who reportedly died four years later due to cyanide poisoning. ![]() When utilizing antidotal therapy for cyanide poisoning, what potential problems associated with administration should the clinician consider before giving each agent?. ![]() Under which clinical scenarios should cyanide poisoning be suspected?.The patient went into cardiac arrest shortly after arrival to the emergency department and subsequently expired despite receiving appropriate antidotal therapy and aggressive resuscitative measures. Urine immunoassay drug of abuse screen was negative.įurther history obtained from the mother revealed that the pill bottle found with the patient contained laetrile which she had been taking to prevent cancer. Ethanol, acetaminophen, and salicylate concentrations were undetectable. Transaminases and other measures of liver function were normal. Initial plasma lactate 17.3 mmol/L (normal range 0 - 2.2 mmol/L). Measured serum osmolarity was 302 mOsm/kg and calculations yielded an osmol gap of 2 (normal range -5 to 15). Serum chemistry was significant for bicarbonate 7 mEq/L, glucose 226 mg/dL and an anion gap of 34. Blood was obtained for analysis immediately following intubation and an arterial blood gas revealed: pH 6.97, pCO2 37 mmHg, and pO2 235 mmHg. Electrocardiogram demonstrated sinus tachycardia but was otherwise normal. The physician decided to intubate the patient to protect his airway. There was no evidence of trauma, and his pupils were equal and reactive to light and bedside glucose test was 231 mg/dL. On examination he was unconscious but did withdraw to painful stimuli in all extremities. His initial vital signs were temperature 36.9 degrees Celsius rectally, blood pressure 72/48 mmHg, heart rate 150 beats/minute, RR 26 breaths/minute, and oxygen saturation 100% on facemask with oxygen flow rate of 15 liters/min. Accidental occupational or environmental exposure as well as intentional poisoning are possible, and rapid recognition and treatment with the appropriate antidote is essential to prevent mortality.Ī 6 year old male with a past medical history of autism presents to the Emergency Department after being found by his parents unresponsive next to an open bottle of pills. It is also found naturally within certain pitted fruits and is a by-product of combustion. Cyanide is widely used across multiple industries including metallurgy, photography, plastic manufacturing, fumigation, jewelry polishing, cosmetics, and chemical synthesis. Updated February, 2023 by Jeremy Hardin, MD and Binh Ly, MDĪcute cyanide poisoning is rare and often life-threatening if untreated.
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