Few published reports have suggested a substantial interaction between cranberry juice and warfarin, although a definite link could not be established. We encountered a patient taking stable doses of warfarin who developed major bleeding and high INR soon after starting daily cranberry juice. No other identifiable reasons for the high INR were apparent. The patient resumed his usual dose of warfarin after stopping the juice. This case suggests a definite relationship between cranberry juice and warfarin.
Numerous cases of cyanide toxicity associated with nitroprusside have been reported. The overall incidence appears to be infrequent; however, certain patients may be at high risk. Risk factors may include hypoalbuminemia, cardiopulmonary bypass procedures, or the administration of moderate to high doses of nitroprusside. Treatment of cyanide toxicity requires the cessation of nitroprusside and, for severe toxicity, use of the cyanide antidote kit. Cyanide toxicity from nitroprusside may be prevented by concomitant administration of sodium thiosulfate infusions.
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