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Arabizadeh N, Mahmoudi M, Gandomani LM, Eizadi‐Mood N. Cyanide poisoning after bitter almond ingestion: "A rare case report". Clin Case Rep 2024; 12:e8418. [PMID: 38197062 PMCID: PMC10774536 DOI: 10.1002/ccr3.8418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 12/19/2023] [Accepted: 12/26/2023] [Indexed: 01/11/2024] Open
Abstract
We present a case of a 36-year-old woman with a history of three suicide attempts who had ingested approximately 40 bitter almonds in a suicidal act, leading to her admission to the emergency department of a regional hospital due to complaints of vomiting. Upon arrival, she exhibited confusion, and her vital signs were recorded as follows: pulse rate = 117 beats/min, blood pressure = 160/85 mmHg, oxygen saturation = 95%, respiratory rate = 16, temperature = 37°C. The patient venous blood gas analysis manifested severe metabolic acidosis (pH = 6.92, pO2 = 43 mmHg, HCO3 = 8.6 mmol/L, pCO2 = 42.7 mmHg, base excess = -25.9 mmol/L). Four hours later, she became unconscious and she was intubated. Gastric lavage and a single dose of 60 g of activated charcoal and sodium bicarbonate were administered. In the referral hospital, sodium nitrite was given due to the severity of the poisoning, and norepinephrine infusion was initiated to manage hypotension. Within a day, the patient regained consciousness, underwent extubation, and after 72 h was discharged and subsequently transferred to psychiatric care for further treatment. This case underscores the critical, life-threatening implications of cyanide toxicity following the ingestion of bitter almonds, highlighting the efficacy of supportive measures such as gastric lavage, activated charcoal, and sodium bicarbonate. Furthermore, it emphasizes the successful application of sodium nitrite monotherapy in managing this condition.
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Affiliation(s)
- Neda Arabizadeh
- School of MedicineIslamic Azad University Najafabad BranchIsfahanIran
- Clinical Toxicology Department, School of Medicine, Isfahan Clinical Toxicology Research CenterIsfahan University of Medical ScienceIsfahanIran
| | - Masoud Mahmoudi
- Clinical Toxicology Department, School of Medicine, Isfahan Clinical Toxicology Research CenterIsfahan University of Medical ScienceIsfahanIran
- School of MedicineIsfahan University of Medical ScienceIsfahanIran
| | - Laaya Mokhtar Gandomani
- Clinical Toxicology Department, School of Medicine, Isfahan Clinical Toxicology Research CenterIsfahan University of Medical ScienceIsfahanIran
| | - Nastaran Eizadi‐Mood
- Clinical Toxicology Department, School of Medicine, Isfahan Clinical Toxicology Research CenterIsfahan University of Medical ScienceIsfahanIran
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2
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Afshar SS, Ziarani GM, Mohajer F, Badiei A, Iravani S, Varma RS. Synthesis of Fumed-Pr-Pi-TCT as a Fluorescent Chemosensor for the Detection of Cyanide Ions in Aqueous Media. WATER 2022; 14:4137. [DOI: 10.3390/w14244137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
In this research, fumed silica scaffolds modified via treatment with (3-chloropropyl)-triethoxysilane, piperazine, and trichlorotriazine groups were deployed for the specific detection of cyanide ions, thus paving the way for the detection of environmental hazards and pollutants with high specificity. Fumed-propyl -piperazine-trichlorotriazine (fumed-Pr-Pi-TCT) was synthesized in three steps starting from fume silica. It was functionalized subsequently using 3-(choloropropyl)-trimethoxysilane, piperazine, and trichlorotriazine, and then, the product was characterized through several methods including Fourier-transform infrared spectroscopy (FTIR) spectrum, thermogravimetric analysis (TGA), and scanning electron microscopy (SEM). Fumed-Pr-Pi-TCT was exposed as a nanoparticle sensor to a range of different anions in aqueous media. This novel sensor could detect cyanide ions as a hazardous material, with the limit of detection being 0.82 × 10−4 M.
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3
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Appenteng MK, Krueger R, Johnson MC, Ingold H, Bell R, Thomas AL, Greenlief CM. Cyanogenic Glycoside Analysis in American Elderberry. Molecules 2021; 26:1384. [PMID: 33806603 PMCID: PMC7961730 DOI: 10.3390/molecules26051384] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 02/06/2023] Open
Abstract
Cyanogenic glycosides (CNGs) are naturally occurring plant molecules (nitrogenous plant secondary metabolites) which consist of an aglycone and a sugar moiety. Hydrogen cyanide (HCN) is released from these compounds following enzymatic hydrolysis causing potential toxicity issues. The presence of CNGs in American elderberry (AE) fruit, Sambucus nigra (subsp. canadensis), is uncertain. A sensitive, reproducible and robust LC-MS/MS method was developed and optimized for accurate identification and quantification of the intact glycoside. A complimentary picrate paper test method was modified to determine the total cyanogenic potential (TCP). TCP analysis was performed using a camera-phone and UV-Vis spectrophotometry. A method validation was conducted and the developed methods were successfully applied to the assessment of TCP and quantification of intact CNGs in different tissues of AE samples. Results showed no quantifiable trace of CNGs in commercial AE juice. Levels of CNGs found in various fruit tissues of AE cultivars studied ranged from between 0.12 and 6.38 µg/g. In pressed juice samples, the concentration range measured was 0.29-2.36 µg/mL and in seeds the levels were 0.12-2.38 µg/g. TCP was highest in the stems and green berries. Concentration levels in all tissues were generally low and at a level that poses no threat to consumers of fresh and processed AE products.
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Affiliation(s)
- Michael K. Appenteng
- Department of Chemistry, University of Missouri, Columbia, MO 65211, USA; (M.K.A.); (R.K.); (M.C.J.); (H.I.)
| | - Ritter Krueger
- Department of Chemistry, University of Missouri, Columbia, MO 65211, USA; (M.K.A.); (R.K.); (M.C.J.); (H.I.)
| | - Mitch C. Johnson
- Department of Chemistry, University of Missouri, Columbia, MO 65211, USA; (M.K.A.); (R.K.); (M.C.J.); (H.I.)
| | - Harrison Ingold
- Department of Chemistry, University of Missouri, Columbia, MO 65211, USA; (M.K.A.); (R.K.); (M.C.J.); (H.I.)
| | - Richard Bell
- Department of Chemistry, Truman State University, Kirksville, MO 63501, USA;
| | - Andrew L. Thomas
- Division of Plant Sciences, Southwest Research Center, University of Missouri, Columbia, MO 65211, USA;
| | - C. Michael Greenlief
- Department of Chemistry, University of Missouri, Columbia, MO 65211, USA; (M.K.A.); (R.K.); (M.C.J.); (H.I.)
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4
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Rice NC, Rauscher NA, Wilkins WL, Lippner DS, Rockwood GA, Myers TM. Behavioural and physiological assessments of dimethyl trisulfide treatment for acute oral sodium cyanide poisoning. Basic Clin Pharmacol Toxicol 2019; 125:289-303. [DOI: 10.1111/bcpt.13220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/01/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Nathaniel C. Rice
- United States Army Medical Research Institute of Chemical Defense Aberdeen Proving Ground Maryland
| | - Noah A. Rauscher
- United States Army Medical Research Institute of Chemical Defense Aberdeen Proving Ground Maryland
| | - William L. Wilkins
- United States Army Medical Research Institute of Chemical Defense Aberdeen Proving Ground Maryland
| | - Dennean S. Lippner
- United States Army Medical Research Institute of Chemical Defense Aberdeen Proving Ground Maryland
| | - Gary A. Rockwood
- United States Army Medical Research Institute of Chemical Defense Aberdeen Proving Ground Maryland
| | - Todd M. Myers
- United States Army Medical Research Institute of Chemical Defense Aberdeen Proving Ground Maryland
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5
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Ralston MSA, Murray MBP, Vela-Duarte D, Orjuela KD, Pastula DM. Neuroterrorism Preparedness for the Neurohospitalist. Neurohospitalist 2018; 9:151-159. [PMID: 31244972 DOI: 10.1177/1941874418806668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In this review article, we highlight several potential biologic and chemical agents of "neuroterrorism" of which neurohospitalists should be aware: anthrax, botulism toxin, brucella, plague, smallpox, organophosphates and nerve agents, cyanide, and carfentanil. Such agents may have direct neurologic effects, resulting in encephalopathy, paralysis, and/or respiratory failure. Neurohospitalists should be on the lookout for abnormal neurologic syndrome clustering, especially among patients presenting to the emergency department. If use of such a "neuroterrorism" agent is suspected, the neurohospitalist should immediately consult with emergency department personnel, infection control, infectious disease physicians, and/or Poison Control to make sure the scene is safe and to stabilize and isolate patients if necessary. The neurohospitalist should also immediately contact their local and/or state health department (or alternatively the US Centers for Disease Control and Prevention Emergency Operations Center) to report their suspicions and to obtain guidance and assistance.
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Affiliation(s)
- Maj Samuel A Ralston
- Emory University School of Medicine, Atlanta, GA, USA.,United States Army, Army Medical Department (AMEDD) Center and School, Fort Sam Houston, TX, USA
| | - Maj Brian P Murray
- Emory University School of Medicine, Atlanta, GA, USA.,United States Air Force, Institute of Technology, Wright-Patterson AFB, OH, USA
| | - Daniel Vela-Duarte
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Karen D Orjuela
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniel M Pastula
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Medicine (Infectious Diseases), University of Colorado School of Medicine, Aurora, CO, USA.,Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
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6
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Case Files of the University of Massachusetts Toxicology Fellowship: Does This Smoke Inhalation Victim Require Treatment with Cyanide Antidote? J Med Toxicol 2017; 12:192-8. [PMID: 26831054 DOI: 10.1007/s13181-016-0533-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Cyanide toxicity is common after significant smoke inhalation. Two cases are presented that provide framework for the discussion of epidemiology, pathogenesis, presenting signs and symptoms, and treatment options of inhalational cyanide poisoning. An evidence-based algorithm is proposed that utilizes point-of-care testing to help physicians identify patients who benefit most from antidotal therapy.
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7
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Jackson R, Logue BA. A review of rapid and field-portable analytical techniques for the diagnosis of cyanide exposure. Anal Chim Acta 2017; 960:18-39. [DOI: 10.1016/j.aca.2016.12.039] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/20/2016] [Accepted: 12/22/2016] [Indexed: 12/22/2022]
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8
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Fueyo L, Robles J, Aguilar I, Yáñez AM, Socias M, Parera M. Hemolysis index to detect degree of hydroxocobalamin interference with common laboratory tests. J Clin Lab Anal 2016; 31. [PMID: 27859624 DOI: 10.1002/jcla.22089] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 10/07/2016] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Cyanokit® (hydroxocobalamin OHCo) is the recommended treatment for cyanide poisoning. OHCo is a red chromophore and may cause interference with some biochemical measurements. In this study, we assessed the possible interference of Cyanokit on several cooximetric and plasma biochemistry tests and then determined the possible mathematical correction for some analytes. We studied the possibility of detecting and evaluating the degree of interference with the hemolysis index (HI) provided by our autoanalyzer because it is not possible to measure the OHCo concentration in conventional laboratories. METHODS Several pools of plasma samples spiked with increasing concentrations of OHCo were prepared. Each one was compared to the pool without interferent. Interference was considered when the bias was more than 10%. An interferograph was developed for those analytes with significant interference. The correlation between interference agent concentration and HI was calculated by Spearman correlation coefficient. We used multiple regression analysis to determine the mathematical correction for amylase, creatinine, and lactate. RESULTS We detected significant interference in the amylase, carboxyhemoglobin, creatinine, creatine kinase, bilirubin, lactate, and total protein measurement. The HI was positively correlated with OHCo concentration. Corresponding equations for estimating lactate and creatinine concentrations were obtained. CONCLUSIONS OHCo interferes with many laboratory assays in an unpredictable way making some results invalid and confounding clinical decision making. We can detect and evaluate the degree of interference with the HI. We can still estimate real creatinine and lactate levels using the regression equation obtained in this study.
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Affiliation(s)
- Laura Fueyo
- Servicio de Análisis Clínicos, Hospital Universitario Son Espases, Palma, Balearic Islands, Spain
| | - Juan Robles
- Servicio de Análisis Clínicos, Hospital Universitario Son Espases, Palma, Balearic Islands, Spain
| | - Irene Aguilar
- Servicio de Análisis Clínicos, Hospital Universitario Son Espases, Palma, Balearic Islands, Spain
| | - Aina M Yáñez
- Instituto de investigación sanitaria de Palma (IdISPa), Palma, Balearic Islands, Spain
| | - Magdalena Socias
- Servicio de Urgencias, Hospital Universitario Son Espases, Palma, Balearic Islands, Spain
| | - Magdalena Parera
- Servicio de Análisis Clínicos, Hospital Universitario Son Espases, Palma, Balearic Islands, Spain
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9
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Stoll S, Roider G, Keil W. Concentrations of cyanide in blood samples of corpses after smoke inhalation of varying origin. Int J Legal Med 2016; 131:123-129. [PMID: 27470320 DOI: 10.1007/s00414-016-1426-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 07/19/2016] [Indexed: 11/29/2022]
Abstract
Cyanide (CN) blood concentration is hardly considered during routine when evaluating smoke gas intoxications and fire victims, although some inflammable materials release a considerable amount of hydrogen cyanide. CN can be significant for the capacity to act and can in the end even be the cause of death. Systematic data concerning the influence of different fire conditions, especially those of various inflammable materials, on the CN-blood concentration of deceased persons do not exist. This study measured the CN level in 92 blood samples of corpses. All persons concerned were found dead in connection with fires and/or smoke gases. At the same time, the carboxyhemoglobin (COHb) level was determined, and the corpses were examined to detect pharmaceutical substances, alcohol and drugs. Furthermore, we analysed autopsy findings and the investigation files to determine the inflammable materials and other circumstances of the fires. Due to the inflammable materials, the highest concentration of CN in the victims was found after enclosed-space fires (n = 45) and after motor-vehicle fires (n = 8). The CN levels in these two groups (n = 53) were in 47 % of the cases toxic and in 13 % of the cases lethal. In victims of charcoal grills (n = 17) and exhaust gases (n = 6), no or only traces of CN were found. Only one case of the self-immolations (n = 12) displayed a toxic CN level. The results show that CN can have considerable significance when evaluating action ability and cause of death with enclosed-space fires and with motor-vehicle fires.
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Affiliation(s)
- Simone Stoll
- Institute of Legal Medicine, Ludwig-Maximilians-University, Nußbaumstraße 26, 80336, Munich, Germany.
| | - Gabriele Roider
- Institute of Legal Medicine, Ludwig-Maximilians-University, Nußbaumstraße 26, 80336, Munich, Germany
| | - Wolfgang Keil
- Institute of Legal Medicine, Ludwig-Maximilians-University, Nußbaumstraße 26, 80336, Munich, Germany
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10
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Lopez-Manzano E, Cronican AA, Frawley KL, Peterson J, Pearce LL. Cyanide Scavenging by a Cobalt Schiff-Base Macrocycle: A Cost-Effective Alternative to Corrinoids. Chem Res Toxicol 2016; 29:1011-9. [PMID: 27104767 PMCID: PMC5555407 DOI: 10.1021/acs.chemrestox.6b00070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The complex of cobalt(II) with the ligand 2,12-dimethyl-3,7,11,17-tetraazabicyclo-[11.3.1]heptadeca-1(17)2,11,13,15-pentaene (CoN4[11.3.1]) has been shown to bind two molecules of cyanide in a cooperative fashion with an association constant of 2.7 (±0.2) × 10(5). In vivo, irrespective of whether it is initially administered as the Co(II) or Co(III) cation, EPR spectroscopic measurements on blood samples show that at physiological levels of reductant (principally ascorbate) CoN4[11.3.1] becomes quantitatively reduced to the Co(II) form. However, following addition of sodium cyanide, a dicyano Co(III) species is formed, both in blood and in buffered aqueous solution at neutral pH. In keeping with other cobalt-containing cyanide-scavenging macrocycles like cobinamide and cobalt(III) meso-tetra(4-N-methylpyridyl)porphine, we found that CoN4[11.3.1] exhibits rapid oxygen turnover in the presence of the physiological reductant ascorbate. This behavior could potentially render CoN4[11.3.1] cytotoxic and/or interfere with evaluations of the antidotal capability of the complex toward cyanide through respirometric measurements, particularly since cyanide rapidly inhibits this process, adding further complexity. A sublethal mouse model was used to assess the effectiveness of CoN4[11.3.1] as a potential cyanide antidote. The administration of CoN4[11.3.1] prophylactically to sodium cyanide-intoxicated mice resulted in the time required for the surviving animals to recover from "knockdown" (unconsciousness) being significantly decreased (3 ± 2 min) compared to that of the controls (22 ± 5 min). All observations are consistent with the demonstrated antidotal activity of CoN4[11.3.1] operating through a cyanide-scavenging mechanism, which is associated with a Co(II) → Co(III) oxidation of the cation. To test for postintoxication neuromuscular sequelae, the ability of mice to remain in position on a rotating cylinder (RotaRod test) was assessed during and after recovery. While intoxicated animals given CoN4[11.3.1] did recover ∼30 min more quickly than controls given only toxicant, there were no indications of longer-term problems in either group, as determined by continuing the RotaRod testing up to 24 h after the intoxications and routine behavioral observations for a further week.
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Affiliation(s)
- Elisenda Lopez-Manzano
- Department of Environmental and Occupational Health, Graduate School of Public Health, The University of Pittsburgh, 100 Technology Drive, Pittsburgh, Pennsylvania 15219, United States
| | - Andrea A. Cronican
- Department of Environmental and Occupational Health, Graduate School of Public Health, The University of Pittsburgh, 100 Technology Drive, Pittsburgh, Pennsylvania 15219, United States
| | - Kristin L. Frawley
- Department of Environmental and Occupational Health, Graduate School of Public Health, The University of Pittsburgh, 100 Technology Drive, Pittsburgh, Pennsylvania 15219, United States
| | - Jim Peterson
- Department of Environmental and Occupational Health, Graduate School of Public Health, The University of Pittsburgh, 100 Technology Drive, Pittsburgh, Pennsylvania 15219, United States
| | - Linda L. Pearce
- Department of Environmental and Occupational Health, Graduate School of Public Health, The University of Pittsburgh, 100 Technology Drive, Pittsburgh, Pennsylvania 15219, United States
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11
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Sabourin PJ, Kobs CL, Gibbs ST, Hong P, Matthews CM, Patton KM, Sabourin CL, Wakayama EJ. Characterization of a Mouse Model of Oral Potassium Cyanide Intoxication. Int J Toxicol 2016; 35:584-603. [PMID: 27170682 DOI: 10.1177/1091581816646973] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Potassium cyanide (KCN) is an inhibitor of cytochrome C oxidase causing rapid death due to hypoxia. A well-characterized model of oral KCN intoxication is needed to test new therapeutics under the Food and Drug Administration Animal Rule. Clinical signs, plasma pH and lactate concentrations, biomarkers, histopathology, and cyanide and thiocyanate toxicokinetics were used to characterize the pathology of KCN intoxication in adult and juvenile mice. The acute oral LD50s were determined to be 11.8, 11.0, 10.9, and 9.9 mg/kg in water for adult male, adult female, juvenile male, and juvenile female mice, respectively. The time to death was rapid and dose dependent; juvenile mice had a shorter mean time to death. Juvenile mice displayed a more rapid onset and higher incidence of seizures. The time to observance of respiratory signs and prostration was rapid, but mice surviving beyond 2 hours generally recovered fully within 8 hours. At doses up to the LD50, there were no gross necropsy or microscopic findings clearly attributed to administration of KCN in juvenile or adult CD-1 mice from 24 hours to 28 days post-KCN challenge. Toxicokinetic analysis indicated rapid uptake, metabolism, and clearance of plasma cyanide. Potassium cyanide caused a rapid, dose-related decrease in blood pH and increase in serum lactate concentration. An increase in fatty acid-binding protein 3 was observed at 11.5 mg/kg KCN in adult but not in juvenile mice. These studies provide a characterization of KCN intoxication in adult and juvenile mice that can be used to screen or conduct preclinical efficacy studies of potential countermeasures.
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12
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Cronican AA, Frawley KL, Ahmed H, Pearce LL, Peterson J. Antagonism of Acute Sulfide Poisoning in Mice by Nitrite Anion without Methemoglobinemia. Chem Res Toxicol 2015; 28:1398-408. [PMID: 25951111 DOI: 10.1021/acs.chemrestox.5b00015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
There are currently no FDA-approved antidotes for H2S/sulfide intoxication. Sodium nitrite, if given prophylactically to Swiss Webster mice, was shown to be highly protective against the acute toxic effects of sodium hydrosulfide (∼LD40 dose) with both agents administered by intraperitoneal injections. However, sodium nitrite administered after the toxicant dose did not detectably ameliorate sulfide toxicity in this fast-delivery, single-shot experimental paradigm. Nitrite anion was shown to rapidly produce NO in the bloodstream, as judged by the appearance of EPR signals attributable to nitrosylhemoglobin and methemoglobin, together amounting to less than 5% of the total hemoglobin present. Sulfide-intoxicated mice were neither helped by the supplemental administration of 100% oxygen nor were there any detrimental effects. Compared to cyanide-intoxicated mice, animals surviving sulfide intoxication exhibited very short knockdown times (if any) and full recovery was extremely fast (∼15 min) irrespective of whether sodium nitrite was administered. Behavioral experiments testing the ability of mice to maintain balance on a rotating cylinder showed no motor impairment up to 24 h post sulfide exposure. It is argued that antagonism of sulfide inhibition of cytochrome c oxidase by NO is the crucial antidotal activity of nitrite rather than formation of methemoglobin.
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Affiliation(s)
- Andrea A Cronican
- Department of Environmental and Occupational Health, Graduate School of Public Health, The University of Pittsburgh, 100 Technology Drive, Pittsburgh, Pennsylvania 15219, United States
| | - Kristin L Frawley
- Department of Environmental and Occupational Health, Graduate School of Public Health, The University of Pittsburgh, 100 Technology Drive, Pittsburgh, Pennsylvania 15219, United States
| | - Humza Ahmed
- Department of Environmental and Occupational Health, Graduate School of Public Health, The University of Pittsburgh, 100 Technology Drive, Pittsburgh, Pennsylvania 15219, United States
| | - Linda L Pearce
- Department of Environmental and Occupational Health, Graduate School of Public Health, The University of Pittsburgh, 100 Technology Drive, Pittsburgh, Pennsylvania 15219, United States
| | - Jim Peterson
- Department of Environmental and Occupational Health, Graduate School of Public Health, The University of Pittsburgh, 100 Technology Drive, Pittsburgh, Pennsylvania 15219, United States
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13
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Physiologically based pharmacokinetic modeling of hydrogen cyanide levels in human breath. Arch Toxicol 2014; 89:1287-96. [DOI: 10.1007/s00204-014-1310-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 07/01/2014] [Indexed: 10/25/2022]
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14
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Empiric Treatment of Cyanide Toxicity in an Enclosed-Space Fire Survivor. J Emerg Nurs 2014; 40:282-5; quiz 293. [DOI: 10.1016/j.jen.2014.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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15
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Bhattacharya R, Singh P, Palit M, Waghmare C, Singh AK, Gopalan N, Kumar D. Time-dependent comparative evaluation of some important biomarkers of acute cyanide poisoning in rats: an aid in diagnosis. Biomarkers 2014; 19:241-51. [DOI: 10.3109/1354750x.2014.902996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Rahul Bhattacharya
- Pharmacology and Toxicology Division, Defence Research and Development Establishment
Gwalior, Madhya PradeshIndia
| | - Poonam Singh
- Pharmacology and Toxicology Division, Defence Research and Development Establishment
Gwalior, Madhya PradeshIndia
| | - Meehir Palit
- Biochemistry Division, Defence Research and Development Establishment
Gwalior, Madhya PradeshIndia
| | - Chandrakant Waghmare
- Biochemistry Division, Defence Research and Development Establishment
Gwalior, Madhya PradeshIndia
| | - Anil Kumar Singh
- Vector Management Division, Defence Research and Development Establishment
Gwalior, Madhya PradeshIndia
| | - Natarajan Gopalan
- Vector Management Division, Defence Research and Development Establishment
Gwalior, Madhya PradeshIndia
| | - Deo Kumar
- Pharmacology and Toxicology Division, Defence Research and Development Establishment
Gwalior, Madhya PradeshIndia
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16
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Huzar TF, George T, Cross JM. Carbon monoxide and cyanide toxicity: etiology, pathophysiology and treatment in inhalation injury. Expert Rev Respir Med 2014; 7:159-70. [DOI: 10.1586/ers.13.9] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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17
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Geldner G, Koch EM, Gottwald-Hostalek U, Baud F, Burillo G, Fauville JP, Levi F, Locatelli C, Zilker T. Report on a study of fires with smoke gas development : determination of blood cyanide levels, clinical signs and laboratory values in victims. Anaesthesist 2013; 62:609-16. [PMID: 23917894 DOI: 10.1007/s00101-013-2209-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 06/13/2013] [Accepted: 06/25/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND This is a report on an international non-interventional study of patients exposed to fires with smoke development in closed rooms. The objective of the study was to document clinical symptoms, relevant laboratory values and blood cyanide concentrations from fire victims in order to confirm or rule out presumptive correlations between the individual parameters. MATERIALS AND METHODS The study was conducted in five European countries with patients being included if they presented with the characteristic clinical signs, such as soot deposits and altered neurological status. Venous blood samples were taken from victims prior to administration of an antidote in all cases and determination of cyanide concentration was performed in a central laboratory using high performance liquid chromatography. RESULTS Data from 102 patients (62 % male, average age 49 years) were included in the evaluation with no blood samples being available for analysis from 2 patients. In 25 patients the blood cyanide concentration was below the limit of detection of 1.2 μmol/l. Cyanide levels between 1.2 and 10 μmol/l were measured in 54 patients, 7 patients had values between 10 and 20 μmol/l, 4 patients between 20 and 40 μmol/l while levels above 40 μmol/l were determined in 10 patients. The results of the study could not demonstrate that the cyanide level was influenced either by the interval between smoke exposure and blood sampling or the duration presence at the fire scene. The following clinical signs or laboratory values were recorded as relevant for increased and possibly toxic cyanide levels: respiratory arrest, dyspnea, resuscitation requirement, tracheal intubation, respiratory support measures, low Glasgow coma scale (GCS) score and respiratory frequency. A correlation between cyanide concentration and the total amount of soot deposits on the face and neck, in the oral cavity and in expectoration was confirmed. A correlation between cyanide and carboxyhemoglobin (COHb) levels in the blood of fire victims was also confirmed. CONCLUSIONS As long as it is not possible to immediately determine the blood cyanide concentration in patients exposed to fire with smoke development, a decreased GCS score, soot deposits particularly in expectoration, dyspnea and convulsions are to be regarded as risk markers for intoxication. In their presence immediate administration of hydroxocobalamin as an antidote is recommended.
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Affiliation(s)
- G Geldner
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Ludwigsburg, 71640, Ludwigsburg, Germany.
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Cigolini D, Ricci G, Zannoni M, Codogni R, De Luca M, Perfetti P, Rocca G. Hydroxocobalamin treatment of acute cyanide poisoning from apricot kernels. BMJ Case Rep 2011; 2011:bcr.03.2011.3932. [PMID: 22694886 DOI: 10.1136/bcr.03.2011.3932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Clinical experience with hydroxocobalamin in acute cyanide poisoning via ingestion remains limited. This case concerns a 35-year-old mentally ill woman who consumed more than 20 apricot kernels. Published literature suggests each kernel would have contained cyanide concentrations ranging from 0.122 to 4.09 mg/g (average 2.92 mg/g). On arrival, the woman appeared asymptomatic with a raised pulse rate and slight metabolic acidosis. Forty minutes after admission (approximately 70 min postingestion), the patient experienced headache, nausea and dyspnoea, and was hypotensive, hypoxic and tachypnoeic. Following treatment with amyl nitrite and sodium thiosulphate, her methaemoglobin level was 10%. This prompted the administration of oxygen, which evoked a slight improvement in her vital signs. Hydroxocobalamin was then administered. After 24 h, she was completely asymptomatic with normalised blood pressure and other haemodynamic parameters. This case reinforces the safety and effectiveness of hydroxocobalamin in acute cyanide poisoning by ingestion.
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Affiliation(s)
- Davide Cigolini
- UOS di Tossicologia Clinica, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
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Carlsson CJ, Hansen HE, Hilsted L, Malm J, Ødum L, Szecsi PB. An evaluation of the interference of hydroxycobalamin with chemistry and co-oximetry tests on nine commonly used instruments. Scandinavian Journal of Clinical and Laboratory Investigation 2011; 71:378-86. [DOI: 10.3109/00365513.2011.573573] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Christian J. Carlsson
- Department of Clinical Biochemistry, Gentofte Hospital, University of Copenhagen,
Hellerup, Denmark
| | - Heidi E. Hansen
- Department of Clinical Biochemistry, Vendsyssel Hospital,
Hjørring, Denmark
| | - Linda Hilsted
- Department of Clinical Biochemistry,
Rigshospitalet, Copenhagen, Denmark
| | - Johan Malm
- Department of Clinical Chemistry, Malmö University Hospital,
Malmö, Sweden
| | - Lars Ødum
- Department of Clinical Biochemistry, Roskilde Hospital,
Roskilde, Denmark
| | - Pal B. Szecsi
- Department of Clinical Biochemistry, Gentofte Hospital, University of Copenhagen,
Hellerup, Denmark
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Mustafa AA, Kowalski SR. A comparative analysis of the Libyan national essential medicines list and the WHO model list of essential medicines. Libyan J Med 2010; 5. [PMID: 21483564 PMCID: PMC3066759 DOI: 10.3402/ljm.v5i0.5403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 10/29/2010] [Accepted: 10/30/2010] [Indexed: 11/26/2022] Open
Abstract
Aim and Objectives To examine the concordance of the Libyan Pharmaceutical List of Essential Medicines (LPLEM) with the World Health Organization Model List of Essential Medicines 2009 (WMLEM 2009). Methods The concordance between generic medicines listed in the WMLEM 2009 (standard reference list) and the LPLEM 2006 (comparator list) was evaluated. Results The total number of Basic Essential Medicines (BEMs) listed on the WMLEM 2009 was 347. The total number of generic medicines listed on the LPLEM was 584. Although the LPLEM has more listed medicines, only 270 (77.6%) of BEMs from the WMLEM were listed as available. However, 25 of the 77 missing medicines were deemed to have appropriate alternatives. A total of 52 medicines from the WMLEM 2009 were therefore missing from the LPLEM. Discrepancies compared to the WMLEM 2009 were identified in 15 out of 29 therapeutic sections. The highest discrepancy rate from the WMLEM 2009 was in the anti-infective section (35 missing medicines). Missing BEMs were noted in many subclassifications of the anti-infective medicines section, but omissions were particularly prevalent in the antibacterial medicines subsection (11 missing medicines). Antituberculosis medications had the highest discrepancy rate for antibacterial BEMs with one-third of the single medicines recommended by the WHO in the WMLEM 2009 not listed on the LPLEM. Of the 314 additional medicines on the LPLEM, 18 were deemed to be irrational non-essential medicines. Conclusion The LPLEM does not include several essential medicines recommended by the WHO in the WMLEM 2009. These discrepancies may have serious public health implications for management of some infectious diseases, particularly, tuberculosis and HIV.
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Affiliation(s)
- Asma Abubakr Mustafa
- Department of Pharmaceutics, Faculty of Pharmacy, Al-Arab Medical University, Benghazi, Libya
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Brenner M, Kim JG, Lee J, Mahon SB, Lemor D, Ahdout R, Boss GR, Blackledge W, Jann L, Nagasawa HT, Patterson SE. Sulfanegen sodium treatment in a rabbit model of sub-lethal cyanide toxicity. Toxicol Appl Pharmacol 2010; 248:269-76. [PMID: 20705081 PMCID: PMC3382974 DOI: 10.1016/j.taap.2010.08.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 07/31/2010] [Accepted: 08/03/2010] [Indexed: 01/13/2023]
Abstract
The aim of this study is to investigate the ability of intramuscular and intravenous sulfanegen sodium treatment to reverse cyanide effects in a rabbit model as a potential treatment for mass casualty resulting from cyanide exposure. Cyanide poisoning is a serious chemical threat from accidental or intentional exposures. Current cyanide exposure treatments, including direct binding agents, methemoglobin donors, and sulfur donors, have several limitations. Non-rhodanese mediated sulfur transferase pathways, including 3-mercaptopyruvate sulfurtransferase (3-MPST) catalyze the transfer of sulfur from 3-MP to cyanide, forming pyruvate and less toxic thiocyanate. We developed a water-soluble 3-MP prodrug, 3-mercaptopyruvatedithiane (sulfanegen sodium), with the potential to provide a continuous supply of substrate for CN detoxification. In addition to developing a mass casualty cyanide reversal agent, methods are needed to rapidly and reliably diagnose and monitor cyanide poisoning and reversal. We use non-invasive technology, diffuse optical spectroscopy (DOS) and continuous wave near infrared spectroscopy (CWNIRS) to monitor physiologic changes associated with cyanide exposure and reversal. A total of 35 animals were studied. Sulfanegen sodium was shown to reverse the effects of cyanide exposure on oxyhemoglobin and deoxyhemoglobin rapidly, significantly faster than control animals when administered by intravenous or intramuscular routes. RBC cyanide levels also returned to normal faster following both intramuscular and intravenous sulfanegen sodium treatment than controls. These studies demonstrate the clinical potential for the novel approach of supplying substrate for non-rhodanese mediated sulfur transferase pathways for cyanide detoxification. DOS and CWNIRS demonstrated their usefulness in optimizing the dose of sulfanegen sodium treatment.
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Affiliation(s)
- Matthew Brenner
- Laser Microbeam and Medical Program, Beckman Laser Institute and Medical Clinic, University of California, Irvine, CA 92612-1475, USA.
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Payen C, Combe C, Le Meur C, Gaillard Y, Pulce C, Descotes J. Lethal acute poisoning with potassium ferrocyanide. Am J Emerg Med 2010; 28:642.e3-5. [DOI: 10.1016/j.ajem.2009.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Accepted: 09/04/2009] [Indexed: 11/30/2022] Open
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Lee J, Keuter KA, Kim J, Tran A, Uppal A, Mukai D, Mahon SB, Cancio LC, Batchinsky A, Tromberg BJ, Brenner M. Noninvasive in vivo monitoring of cyanide toxicity and treatment using diffuse optical spectroscopy in a rabbit model. Mil Med 2010; 174:615-21. [PMID: 19585775 DOI: 10.7205/milmed-d-02-7408] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Currently, no reliable noninvasive methods exist for monitoring the severity of in vivo cyanide (CN) toxicity, treatment, and resulting physiological changes. We developed a broadband diffuse optical spectroscopy (DOS) system to measure bulk tissue absorption and scattering. DOS was used to optically monitor CN toxicity and treatment with sodium nitrite (NaNO2). To perform experiments, the DOS probe was placed on the hind leg of rabbits. A sodium CN solution was infused intravenously. DOS and concurrent physiologic measurements were obtained. After completion of CN infusion, NaNO2 was infused to induce methemoglobinemia (MetHb). During infusion of CN, blood gas measurements showed an increase in venous partial pressure of oxygen (pO2), and following reversal, venous pO2 values decreased. DOS measurements demonstrated corresponding changes in hemoglobin oxygenation states and redox states of cytochrome-c oxidase (CcO) during CN infusion and NaNO2 treatment. Therefore, DOS enables detection and monitoring of CN toxicity and treatment with NaNO2.
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Affiliation(s)
- Jangwoen Lee
- Laser Microbeam and Medical Program, Beckman Laser Institute, University of California, 1002 Health Sciences Road East, Irvine, CA 92612-1475, USA
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Intramuscular cobinamide sulfite in a rabbit model of sublethal cyanide toxicity. Ann Emerg Med 2010; 55:352-63. [PMID: 20045579 DOI: 10.1016/j.annemergmed.2009.12.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Revised: 11/19/2009] [Accepted: 12/02/2009] [Indexed: 01/01/2023]
Abstract
STUDY OBJECTIVE Exposure to cyanide in fires and industrial exposures and intentional cyanide poisoning by terrorists leading to mass casualties is an ongoing threat. Current treatments for cyanide poisoning must be administered intravenously, and no rapid treatment methods are available for mass casualty cyanide exposures. Cobinamide is a cobalamin (vitamin B(12)) analog with an extraordinarily high affinity for cyanide that is more water-soluble than cobalamin. We investigate the use of intramuscular cobinamide sulfite to reverse cyanide toxicity-induced physiologic changes in a sublethal cyanide exposure animal model and determine the ability of an intramuscular cobinamide sulfite injection to rapidly reverse the physiologic effects of cyanide toxicity. METHODS New Zealand white rabbits were given 10 mg sodium cyanide intravenously over 60 minutes. Quantitative diffuse optical spectroscopy and continuous-wave near-infrared spectroscopy monitoring of tissue oxyhemoglobin and deoxyhemoglobin concentrations were performed concurrently with blood cyanide level measurements and cobinamide levels. Immediately after completion of the cyanide infusion, the rabbits were injected intramuscularly with cobinamide sulfite (n=6) or inactive vehicle (controls, n=5). RESULTS Intramuscular administration led to rapid mobilization of cobinamide and was extremely effective at reversing the physiologic effects of cyanide on oxyhemoglobin and within deoxyhemoglobin extraction. Recovery time to 63% of their baseline values in the central nervous system occurred within a mean of 1,032 minutes in the control group and 9 minutes in the cobinamide group, with a difference of 1,023 minutes (95% confidence interval 116 to 1,874 minutes). In muscle tissue, recovery times were 76 and 24 minutes, with a difference of 52 minutes (95% confidence interval 7 to 98 minutes). RBC cyanide levels returned toward normal significantly faster in cobinamide sulfite-treated animals than in control animals. CONCLUSION Intramuscular cobinamide sulfite rapidly and effectively reverses the physiologic effects of cyanide poisoning, suggesting that a compact cyanide antidote kit can be developed for mass casualty cyanide exposures.
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Brenner M, Mahon SB, Lee J, Kim J, Mukai D, Goodman S, Kreuter KA, Ahdout R, Mohammad O, Sharma VS, Blackledge W, Boss GR. Comparison of cobinamide to hydroxocobalamin in reversing cyanide physiologic effects in rabbits using diffuse optical spectroscopy monitoring. JOURNAL OF BIOMEDICAL OPTICS 2010; 15:017001. [PMID: 20210475 PMCID: PMC2816993 DOI: 10.1117/1.3290816] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Our purpose is to compare cobinamide to hydroxocobalamin in reversing cyanide (CN)-induced physiologic effects in an animal model using diffuse optical spectroscopy (DOS). Cyanide poisoning is a major threat worldwide. Cobinamide is a novel molecule that can bind two molecules of cyanide, has a much higher binding affinity than hydroxocobalamin, and is more water soluble. We investigated the ability of equimolar doses of cobinamide and hydroxocobalamin to reverse the effects of cyanide exposure in an animal model monitored continuously by DOS. Cyanide toxicity was induced in 16 New Zealand white rabbits by intravenous infusion. Animals were divided into three groups: controls (n=5) received saline following cyanide, hydroxocobalamin (N=6) following cyanide, and cobinamide (N=5) following cyanide. Cobinamide caused significantly faster and more complete recovery of oxy- and deoxyhemoglobin concentrations in cyanide-exposed animals than hydroxocobalamin- or saline-treated animals, with a recovery time constant of 13.8+/-7.1 min compared to 75.4+/-25.1 and 76.4+/-42.7 min, for hydroxocobalamin- and saline-treated animals, respectively (p<0.0001). This study indicates that cobinamide more rapidly and completely reverses the physiologic effects of cyanide than equimolar doses of cobalamin at the dose used in this study, and CN effects and response can be followed noninvasively using DOS.
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Affiliation(s)
- Matthew Brenner
- University of California, Beckman Laser Institute, Irvine, California 92612-1475, USA.
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Uhl W, Nolting A, Gallemann D, Hecht S, Kovar A. Changes in blood pressure after administration of hydroxocobalamin: Relationship to changes in plasma cobalamins-(III) concentrations in healthy volunteers. Clin Toxicol (Phila) 2009; 46:551-9; discussion 576-7. [DOI: 10.1080/15563650701829763] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Abstract
There is well-founded concern that a chemical or radioactive agent will at some point be used as a weapon of terror. There are several antidotes that, if used correctly in a timely fashion, can help lessen the harm caused by these agents. This article is meant to introduce the clinician to several such agents, along with the antidotes useful in the management of exposure to these. It covers the indications, administration, and precautions for using these antidotes.
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Affiliation(s)
- David T Lawrence
- Blue Ridge Poison Center, Division of Medical Toxicology, Department of Emergency Medicine, University of Virginia, Charlottesville, VA 22908-0774, USA.
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