Cyanide toxicity is common after significant smoke inhalation. Two cases are presented that provide framework for the discussion of epidemiology, pathogenesis, presenting signs and symptoms, and treatment options of inhalational cyanide poisoning. An evidence-based algorithm is proposed that utilizes point-of-care testing to help physicians identify patients who benefit most from antidotal therapy.

01 Jun 2007·Annals of Emergency Medicine

Is Hydroxocobalamin Safe and Effective for Smoke Inhalation? Searching for Guidance in the Haze

Review

Author: Andrew R. Erdman

Smoke inhalation is an important cause of fire-related morbidity and mortality, accounting for several thousand deaths annually in the United States. 1 Like carbon monoxide, hydrogen cyanide is a gaseous combustion product found in individuals with closed-space smoke exposure, and empiric treatment of smoke inhalation victims with a cyanide antidote has been recommended by some authors. 2-4 Until recently, the only approved antidote in the United States was the multicomponent cyanide antidote package (Akorn Inc, Taylor Pharmaceuticals, Decatur, IL); Cyanokit® (manufactured for EMD Pharmaceuticals Inc by Merck Sante s.a.s. in Semoy, France, packaged by Dey L.P., Napa, CA) consisting of amyl nitrite, sodium nitrite, and sodium thiosulfate. Unfortunately, nitrites can cause hypotension and excessive methemoglobinemia, precluding their use for smoke inhalation, and sodium thiosulfate may act too slowly to benefit. Outside the United States, an alternative antidote h long been available in the form of hydroxocobalamin. Cumulative data from animal models of cyanide poisoning suggest it has an efficacy comparable to the cyanide antidote package; however, like the cyanide antidote package, human efficacy data are limited to anecdotal reports, case series, and uncontrolled studies. Since hydroxocobalamin is associated with neither methemoglobinemia nor hypotension, clinicians in some countries consider it safe for empiric administration to smoke inhalation victims. 3,4

01 Apr 1983·Toxicology LettersQ2 · MEDICINE

The mutagenicity of a cyanide antidote, dimethylaminophenol, in Chinese hamster cells

Q2 · MEDICINE

Article

Author: C.G. Lee ; T.D. Webber

The mutagenic activity of a cyanide antidote, dimethylaminophenol (DMAP), has been studied at the hypoxanthine-guanine-phosphoribosyltransferase (HPRT) locus in a line of Chinese hamster cells (V79), using induced resistance to 8-azaguanine as a marker for forward, point mutation. In a replating type of assay DMAP produced a dose-dependent increase in mutation frequency in suspension-treated cells, in the absence of any extrinsic metabolic activation system. The incorporation of a liver microsome preparation raised the concentration of DMAP required to induce mutation, but similar levels of induced mutation frequency (IMF) were produced.

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