Cyanide Toxicity
Considerations
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Life threatening emergency with high morbidity/mortality
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Need to consult medical toxologist or poison control & treat appropriately without delay
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Coexisting diseases:
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Burns: carbon monoxide poisoning, smoke inhalation
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Co-ingestions
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Treatment
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Consult toxicology/ICU
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Secure airway & administer 100% O2
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Ensure all medical personnel have suits & respirators; decontaminate the patient (strip & discard clothing, wash all surfaces with soap & water)
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Antidotes:
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Cyanide scavengers:
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IV hydroxocobalamin = 1st line (dose = 70mg/kg, repeat X1 if needed)
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Nitrate such as IV sodium nitrite &/or inhaled amyl nitrite
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Downside is formation of methemoglobin & can cause hypotension, so hydroxycobalamin may be preferred
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Sodium thiosulfate: 25 mL of 50% solution:
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In the body, HCN is broken down by rhodanase, which detoxifies cyanide to thiocyanate
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This process can be accelerated by provision of sodium thiosulfate, which provides a store of sulfane sulfur for the enzyme
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