Treatment of Acute Cyanide Intoxication with Hemodialysis

Wesson, Donald E.; Foley, Richard J.; Sabatini, Sandra; Wharton, Jacqueline; Kapusnik, Joan E.; Kurtzman, Neil A.

doi:10.1159/000166918

Cited by 22 publications

(4 citation statements)

References 9 publications

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“…Hemodialysis has been advocated in some cases of cyanide toxicity; it would be particularly beneficial in the face of worsening acidosis and failing renal function, which would cause thiosulfate to accumulate and induce its own additional toxicity. 65…”

Section: Cyanide Is Extremely Quick To Act and There Is Often Limitementioning

confidence: 99%

Cyanide Poisoning and Its Treatment

2004

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Cyanide is both widely available and easily accessible throughout the world. Although the compound is not frequently encountered, it has been used as a poison and contaminant in the past and is a potential terrorist agent. Cyanide has the ability to cause significant social disruption and demands special attention to public health preparedness. It can be obtained from a variety of sources, including industrial, medical, and even common household products. Another frequently encountered source of cyanide exposure is residential fires. Exposure to high concentrations of the chemical can result in death within seconds to minutes. Long-term effects from cyanide exposure can cause significant morbidity. The only treatment for cyanide toxicity approved for use in the United States is a kit consisting of amyl nitrite, sodium nitrite, and sodium thiosulfate. Future research aims to find a faster-acting, more effective, and better tolerated treatment for cyanide toxicity.

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Section: Cyanide Is Extremely Quick To Act and There Is Often Limitementioning

confidence: 99%

Cyanide Poisoning and Its Treatment

2004

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“…One animal study found that the haemodialysis clearance of cyanide is increased in the presence of thiosulphate, with a clearance of 38.3±5.4 mL/min and an extraction ratio of 0.43±0.06. 11 In retrospect, this case raises interesting points and further questions. It reinforces the importance of decontamination following poisoning with an unknown substance.…”

Section: Haemodialysis Treatmentmentioning

confidence: 89%

Haemodiafiltration for Poisoning with an Unknown Substance

Cottle

Dean²,

Mousdale³

2009

Journal of the Intensive Care Society

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We describe the case of a young male, found collapsed following poisoning with an unknown substance. He had a Glasgow Coma Score (GCS) of three with a profound metabolic acidosis, despite poisoning with a substance which was strongly basic. He was treated with haemodiafiltration to correct the biochemical derangements. The poison was found to be cyanide, so the patient was also given sodium thiosulphate as an antidote. We review the pathophysiology of cyanide toxicity, the antidotes available and discuss the role of haemodiafiltration in poisoning where the ingested substance is unknown.

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“…We have recently reported the effectiveness of hemodialysis in cyanide poisoning (54). At first glance, this appears to be an unlikely mode of therapy for cyanide toxicity for two reasons: first, the lethal effects of cyanide are related to its intracellular action on metabolism; second, the renal clearance of cyanide is virtually zero.…”

Section: C) Hemodialysismentioning

confidence: 99%

“…When a constant infusion of KCN was given to anephric animals an increase in the lethal dose resulted when hemodialysis was used concomitantly. The hemodialysis clearance of cyanide was found to be "" 40 ml/min and the extraction ratio was 0.43 (54). We reasoned that as an intracellular toxin, maneuvers forcing cyanide from inside the cell into the extracellular fluid should be even more effective in preventing mortality.…”

Section: C) Hemodialysismentioning

confidence: 99%

Cyanide Poisoning: Pathophysiology and Current Approaches to Therapy

Gonzales

Sabatini

1989

Int J Artif Organs

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Considering the difficulties following the administration of nitrites (or aminophenols) or cobalt-EDTA as well as the ineffectivenes of hydroxycobalamin and pyruvate, we feel that a more sensible treatment for acute cyanide intoxication is hemodialysis combined with the intravenous administration of sodium thiosulfate. The addition of hemodialysis to such a regimen is helpful in three ways. First, it removes the small extracellular reservoir of cyanide, particularly if the poison is still being absorbed from the gastrointestinal tract. Second, it corrects the severe lactic acidosis seen in virtually all cases of cyanide toxicity. As with most poisons death from metabolic acidosis alone is likely. Third, the removal of thiocyanate, the end product of cyanide metabolism, results in a maneuver which should decrease both tissue and plasma cyanide levels. The immediate treatment of acute cyanide intoxication is supportive, as it is with most all drugs and poisons. Gastric lavage using activated charcoal should be initiated immediately to remove any remaining cyanide in the gastrointestinal tract. Simultaneously, high flow oxygen should be administered either by nasal cannula or by endotracheal intubation. Correction of the metabolic acidosis should be instituted with bicarbonate. Immediate hemodialysis should be performed with the concomitant administration of thiosulfate. Animal studies suggest that continuous infusion of thiosulfate (12 mg/kg/hr) is more effective for treating cyanide intoxication than is bolus administration (41, 51). Bolus administration is the currently recommended form of thiosulfate therapy in humans. The Lilly kit contains a 50 ml ampule of thiosulfate having 12.5 gm, which in adults may be repeated once at one-half the dose.(ABSTRACT TRUNCATED AT 250 WORDS)

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Treatment of Acute Cyanide Intoxication with Hemodialysis

Cited by 22 publications

References 9 publications

Cyanide Poisoning and Its Treatment

Cyanide Poisoning and Its Treatment

Haemodiafiltration for Poisoning with an Unknown Substance

Cyanide Poisoning: Pathophysiology and Current Approaches to Therapy

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