Patterns of cyanide antidote use since regulatory approval of hydroxocobalamin in the United States. Streitz MJ, Bebarta VS, Borys DJ, Morgan DL. Cyanide poisoning and cardiac disorders: 161 cases. 2006 44 Suppl 1:5–15.įortin JL, Desmettre T, Manzon C, Judic-Peureux V, Peugeot-Mortier C, Giocanti JP, Hachelaf M, Grangeon M, Hostalek U, Crouzet J, Capellier G. Efficacy of hydroxocobalamin for the treatment of acute cyanide poisoning in adult beagle dogs. Cyanide-induced neurotoxicity: role of neuronal calcium. Sodium thiosulfate or hydroxocobalamin for the empiric treatment of cyanide poisoning? Ann Emerg Med. Which cyanide antidote? Crit Rev Toxicol. Dimethyl trisulfide: a novel cyanide countermeasure. Insufficient stocking of cyanide antidotes in US hospitals that provide emergency care. Hydroxocobalamin: improved public health readiness for cyanide disasters. Cyanide poisoning by fire smoke inhalation: an European expert consensus. Epub 8.Īnseeuw K, Delvau N, Burillo-Putze G, De Iaco F, Geldner G, Holmstrom P, Lambert Y, Sabbe M. Review article: management of cyanide poisoning. Reade MC, Davies SR, Morley PT, Dennett J, Jacobs IC. Emergency preparedness and response: cyanide 2008. 2014 annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 32nd annual report. Mowry JB, Spyker DA, Brooks DE, McMillan N, Schauben JL. Swedish forensic data 1992–2009 suggest hydrogen cyanide as an important cause of death in fire victims. Stamyr K, Thelander G, Ernstgard L, Ahlner J, Johanson G. Case files of the University of Massachusetts toxicology fellowship: does this smoke inhalation victim require treatment with cyanide antidote? J Med Toxicol. The availability of antidotal therapy also is subject to impact from both market and regulatory forces. Several treatments are available to treat cyanide toxicity, and clinical practice guidelines are available. Cyanide also creates an occupational hazard in industries such as electroplating, metal extraction, pest control, and oil field work. Recent events have highlighted the need for preparedness against possible chemical terrorist attacks. The largest threat of cyanide toxicity is actually the result of terrorism and war. There are as many deaths each year in the United States as from cardiac glycosides, beta blockers alone, or organophosphates. While fortunately less common, the most interesting cause of cyanide toxicity come from suicidal and homicidal acts. The most common cause of cyanide toxicity is inhaled cyanide (hydrogen cyanide) from structure fires. With an understanding of these concepts, you too, will be able to treat that secret agent who is trying to kill himself (or herself) before they reveal the secret plans.Cyanide exposure can cause rapid death. This is complicated by the lack of a readily available assay and the variability of available antidotes. The management of cyanide poisoning requires firstly the identification of patients who may be at risk of cyanide poisoning and the selection of antidotes. ![]() Hydroxocobalamin is widely used in Europe but only has limited availability in North America and Australia. In North America amyl nitrate pearls for inhalation can also used be used. In Australia dicobalt edetate IV, sodium nitrite IV and sodium thiosulfate are available. The availability of antidotes to cyanide poisoning varies around the world. Another source of cyanide includes the combustion of wool, silk, synthetic rubber and polyurethane. ![]() Deliberate contamination of medications and food has occurred recently. ![]() Suicides are the commonest cause of cyanide poisoning. ![]() Industries that use cyanide include metal extraction and refining, electroplating, photography and fumigation. It is important to know the unique mechanism of action of this poison as delay in treatment can have disastrous consequences to the patient. It is used in many chemical compounds including medications and can be found endogenously in plant and bacteria. Its toxicity was soon discovered by Scheele who, upon breaking the flask of his newly found fluid, was killed by the resulting vapours.Ĭyanide is a rapidly toxic agent that is found in liquid and gaseous form. Hydrogen cyanide was not isolated in a pure form until 1786 when Scheele extracted it from the dye Prussian blue.
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