Counteraction of cyanide poisoning by thiosulphate when administering sodium nitroprusside as a hypotensive treatment

Schulz, Volker; Bonn, R.; Kämmerer, Hermann; Kriegel, R.; Ecker, N.

doi:10.1007/bf01477029

Cited by 8 publications

(1 citation statement)

References 6 publications

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“…Physiological levels of cyanide are metabolized to thiocyanate by the enzyme rhodanese, which requires thiosulphate as a substrate. The body's reserve of thiosulphate is limited, 4,53 suggesting supplementation might be beneficial in cyanide poisoning. However, rhodanese is located within mitochondria, and thiosulphate penetrates cell and mitochondrial membranes poorly 4 .…”

Section: Resultsmentioning

confidence: 99%

Review article: Management of cyanide poisoning

Reade

Davies

Morley

et al. 2012

Emerg Medicine Australasia

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Cyanide poisoning is uncommon, but generates interest because of the presumed utility of an antidote immediately available in those areas with a high risk of cyanide exposure. As part of its regular review of guidelines, the Australian Resuscitation Council conducted a systematic review of the human evidence for the use of various proposed cyanide antidotes, and a narrative review of the relevant pharmacological and animal studies. There have been no relevant comparative or placebo-controlled human trials. Nine case series were identified. Treatment with hydroxocobalamin was reported in a total of 361 cases. No serious adverse effects of hydroxocobalamin were reported, and many patients with otherwise presumably fatal poisoning survived. Sodium thiosulphate use was reported in two case series, similarly with no adverse effects. Treatment with a combination of sodium nitrite, amyl nitrite and sodium thiosulphate was reported in 74 patients, with results indistinguishable from those of hydroxocobalamin and sodium thiosulphate. No case series using dicobalt edetate or 4-dimethylaminophenol were identified, but successful use in single cases has been reported. Hydroxocobalamin and sodium thiosulphate differ from alternatives in having negligible adverse effects, and on the basis of current evidence are the antidotes of choice. The indications for the use of an antidote, the requirements for supportive care and a recommended approach for workplaces where there is a risk of cyanide poisoning are presented.

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Section: Resultsmentioning

confidence: 99%

Review article: Management of cyanide poisoning

Reade

Davies

Morley

et al. 2012

Emerg Medicine Australasia

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A Retrospective Study of Sodium Nitroprusside Use and Assessment of the Potential Risk of Cyanide Poisoning

Johanning,

Zaske,

Tschida

et al. 1995

Pharmacotherapy

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Sodium nitroprusside (SNP) is an effective vasodilator but is potentially dangerous due to its cyanide content. Infusion rates above 2 μg/kg/minute may cause cyanide to accumulate to toxic concentrations in critically ill patients. Coadministration of thiosulfate with SNP effectively and safely prevents cyanide toxicity. This study determined if patients at our institution were treated with SNP infusion rates that could cause cyanide toxicity and whether those patients were administered thiosulfate. We reviewed the charts of 36 critically ill patients treated with SNP during the previous 12 months. In 72% of patients the SNP infusion rates were above 2 μg/kg/minute. In 47% the rates were greater than 2 μg/kg/minute for 6 hours or more, and in 20% they were greater than 5 μg/kg/minute for up to 11 hours. None of the patients was administered thiosulfate. In a significant number of patients the infusion rates of SNP potentially exposed them to significant risk of cyanide toxicity including death.

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Interactions of Anesthetic Drugs and Muscle Relaxants with those Drugs Commonly Used for Controlled Hypotension

Hempel

Münch

1985

Controlled Hypotension in Neuroanaesthesia

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Counteraction of cyanide poisoning by thiosulphate when administering sodium nitroprusside as a hypotensive treatment

Cited by 8 publications

References 6 publications

Review article: Management of cyanide poisoning

Review article: Management of cyanide poisoning

A Retrospective Study of Sodium Nitroprusside Use and Assessment of the Potential Risk of Cyanide Poisoning

Interactions of Anesthetic Drugs and Muscle Relaxants with those Drugs Commonly Used for Controlled Hypotension

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