The cyanide antidote kit is an alternative therapy for cyanide toxicity. The drug's red color can interfere with certain spectrophotometric laboratory tests, including COHb and possibly serum lactate, and blood samples should be obtained before the administration of the first dose of hydroxocobalamin. Inexperienced clinicians often mistake this side effect is as an “allergic” reaction to the drug. The known adverse effects of hydroxocobalamin are mild and include hypertension in those not cyanide poisoned and a bright red discoloration of the patient's skin. Thiosulfate (see later), 12.5 g, can be administered concomitantly over 10 minutes through a separate IV. The initial dose is 5 g intravenous (IV) over 15 minutes for adults and 70 mg/kg IV for children, up to an adult dose, and can be repeated once if an incomplete response is noted. On binding of cyanide, cyanocobalamin, or vitamin B 12, is formed. The preferred antidote is hydroxocobalamin, which takes advantage of the high affinity of cobalt for cyanide.
There are two types of antidotal therapy for cyanide. The accepted goal of therapy is to reactivate the cytochrome oxidase system by providing an alternative binding site for the cyanide ion. Walls MD, in Rosen's Emergency Medicine: Concepts and Clinical Practice, 2018 Hydrogen Cyanide A number of significant health problems arise from the misuse of poppers, including immune system suppression, red blood cell dysfunction, and overdose. They also relax involuntary smooth muscles found in the vagina and anus. Like other inhalant drugs of abuse (see Chapter 25), amyl nitrite can produce euphoria and increase sexual libido.
Thiosulfate is then administered to convert cyanide to inactive thiocyanate.Īmyl nitrite and other similar agents are sometimes abused and used recreationally, called “poppers.” They became popular with gay males in urban settings now they are abused among a variety of persons associated with the club scene. In comparison with hemoglobin, methemoglobin has a greater affinity for cyanide, and this allows it to trap the compound in the form of cyanmethemoglobin.
The nitrites oxidize hemoglobin to methemoglobin. In patients with cyanide poisoning, amyl nitrite is used until intravenous sodium nitrite and sodium thiosulfate can be administered. Amyl nitrite is effective in the treatment of acute angina attacks, as well as in the initial management of cyanide poisoning. Its action is rapid in onset (within 30 seconds) and brief in duration (3–5 minutes). Brenner PhD, in Brenner and Stevens’ Pharmacology, 2018 Amyl NitriteĪmyl nitrite is a volatile liquid that can be inhaled and absorbed through the lungs.
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