General Approach to Cyanide Poisoning: A Review Article

Yıl 2020, Cilt: 2 Sayı: 1, 1 - 6, 24.03.2020

Gülşah Çıkrıkçı Işık Yunsur Çevik

Öz

Cyanide is a rapidly acting, lethal poison that interfere with mitochondrial oxygen utilization. It has many natural, industrial and even household sources. Most common cause of cyanide poisoning is smoke inhalation. Intravenous and inhaled cyanide exposures produce more rapid onset of signs and symptoms than does oral or transdermal ingestions. The clinical presentation varies with the physicochemical form of cyanide, the dose, route of entry, co-toxicants delay since exposure. Central nervous system and cardiovascular system dysfunction are most prominent; also there are nonspecific sings such as nausea, vomiting, headache, dizziness, confusion, coma, seizures, dilated pupils, and abnormal vital signs. Cyanide toxicity expected to have two characteristic symptoms theoretically; those are cherry-red skin and odor of bitter almond from the victims’ breath. Cyanide-poisoned patients have an elevated blood lactate concentration. A cutoff point of 8 mmol/L lactate level should be suggested as a diagnostic indicator of cyanide toxicity. Blood cyanide level is the confirmatory test for cyanide poisoning and but it is not routinely performed in most hospitals and may not correlate with toxicity; therefore it cannot guide treatment. The treatment of patients poisoned with cyanide includes supportive care and adjunctive antidotal therapy. Cyanide toxicity is rapidly lethal, so clinicians must stabilize the patient’s airway, breathing and circulation first. Antidotal treatment of cyanide poisoning involves three strategies which are binding of cyanide, induction of methemoglobinemia, and use of sulfur donors. Hydroxocobalamin and dicobalt edetate are direct cyanide binding antidotes. In general hydroxocobalamin as first-line antidotal therapy is effective and safe in acute cyanide poisoning. Amily nitrite, sodium nitrite and 4dimethylaminophenol are the antidotes that induce methemoglobinemia. Nitrites are not suitable for fire victims, and those with poor cardiopulmonary reserve. Sodium thiosulfate is a sulfur donor antidote. Recommendation for antidotal treatment strategies in case of cyanide poisoning depends on the availability of antidotes and accuracy of the diagnosis.

Anahtar Kelimeler

Cyanide, Poisoning, Antidotes, Hydroxocobalamin, Nitrites

Kaynakça

• 1. Hamel J. A review of acute cyanide poisoning with a treatment update. Crit Care Nurse. 2011; 31(1):72-81; quiz 82.
• 2. Reade MC, Davies SR, Morley PT, Dennett J, Jacobs IC. Review article: management of cyanide poisoning. Emerg Med Australas. 2012; 24(3): 225-38.
• 3. MacLennan L, Moiemen N. Management of cyanide toxicity in patients with burns. Burns. 2015; 41(1): 18-24.
• 4. Kaita Y, Tarui T, Shoji T, Miyauchi H, Yamaguchi Y. Cyanide poisoning is a possible cause of cardiac arrest among fire victims, and empiric antidote treatment may improve outcomes. Am J Emerg Med. 2018; 36(5): 851-853.
• 5. Karadeniz H, Birincioğlu İ, Zazoğlu S, Ketenci HÇ. The importance of the toxicological analysis of death cases caused by cyanide poisoning: A case report. J For Med 2017; 31(2):96-100
• 6. Prochalska C, Megarbane B, El Balkhi S, Poupon J, Baud FJ, Garnier R. Poisoning with gold potassium cyanide and other metallic cyanides in a jeweler. Clin Toxicol (Phila). 2014; 52(8):907-8.
• 7. Thomas C, Svehla L, Moffett BS. Sodium-nitroprusside-induced cyanide toxicity in pediatric patients. Expert Opin Drug Saf. 2009; 8(5):599-602.
• 8. Sips PY, Shi X, Musso G, Nath AK, Zhao Y, Nielson J, et al. Identification of specific metabolic pathways as druggable targets regulating the sensitivity to cyanide poisoning. PLoS One. 2018; 13(6):e0193889. doi: 10.1371/journal.pone.0193889.
• 9. Shoma D, Mark S. Cyanide poisoning. (Revised 2019 Mar 25, Cited 2020 Feb 17.) Avaliable from: https://www.uptodate.com/contents/cyanide-poisoning.
• 10. Nelson L. Acute cyanide toxicity: mechanisms and manifestations. J Emerg Nurs. 2006; 32(4 Suppl):S8-11.
• 11. Borron SW, Baud FJ. Antidotes for acute cyanide poisoning. Curr Pharm Biotechnol. 2012; 13(10): 1940-8.
• 12. Suman SG, Gretarsdottir JM. Chemical and Clinical Aspects of Metal-Containing Antidotes for Poisoning by Cyanide. Met Ions Life Sci. 2019;14(19): 359-391.
• 13. Parker-Cote JL, Rizer J, Vakkalanka JP, Rege SV, Holstege CP. Challenges in the diagnosis of acute cyanide poisoning. Clin Toxicol (Phila). 2018;56(7): 609-617.
• 14. Mohan A, Lee T, Sachdev P. Surviving acute cyanide poisoning: a longitudinal neuropsychological investigation with interval MRI. BMJ Case Rep. 2014. doi: 10.1136/bcr-2013-203025.
• 15. Hsiao PJ, Chang CF, Chiu CC, Chan JS, Chiang WF, Wu CC, et al. High Anion Gap Metabolic Acidosis after a Suicide Attempt with Cyanide: The Rebirth of Cyanide Poisoning. Intern Med. 2015; 54(15): 1901-4.
• 16. Baud FJ, Haidar MK, Jouffroy R, Raphalen JH, Lamhaut L, Carli P. Determinants of Lactic Acidosis in Acute Cyanide Poisonings. Crit Care Med. 2018; 46(6): e523-e529. doi: 10.1097/CCM.0000000000003075.
• 17. Borron SW, Baud FJ, Mégarbane B, Bismuth C. Hydroxocobalamin for severe acute cyanide poisoning by ingestion or inhalation. Am J Emerg Med. 2007; 25(5): 551-8.
• 18. Thompson JP, Marrs TC. Hydroxocobalamin in cyanide poisoning. Clin Toxicol (Phila). 2012; 50(10): 875-85.
• 19. Marrs TC, Thompson JP. The efficacy and adverse effects of dicobalt edetate in cyanide poisoning. Clin Toxicol (Phila). 2016; 54(8): 609-14.
• 20. Lavon O, Avrahami A, Eisenkraft A. Effectiveness of isosorbide dinitrate in cyanide poisoning as a function of the administration timing. BMC Pharmacol Toxicol. 2017 Mar 14; 18(1):13.
• 21. Mégarbane B, Delahaye A, Goldgran-Tolédano D, Baud FJ. Antidotal treatment of cyanide poisoning. J Chin Med Assoc. 2003; 66(4):193-203.