Hydroxocobalamin for Cyanide Poisoning - @ JEMS.com


Hydroxocobalamin for Cyanide Poisoning

Street Science


 
 

Keith Wesley | | Wednesday, July 4, 2007


Review of: Hall A, Dart R, Bogdan G: Sodium thiosulfate or hydroxocobalamin for the empiric treatment of cyanide poisoning? Annals of Emergency Medicine. 49:806 813, 2007.

The Science

This comprehensive review by the authors examines the pros and cons of two cyanide antidote treatments sodium thiosulfate, which is a component of the commonly referred to Pasadena or Lilly kit, and hydroxocobalamin, which is a precursor of vitamin B12 and has been in use for years in many countries and exclusively in Europe.

The authors review the current literature supporting the use of these agents as well as the current research that indicates the need for increased awareness of cyanide poisoning in combination with smoke inhalation. They state that empiric treatment, which would be the automatic administration of a given therapy when the condition is suspected, should be both safe and effective.

They conclude that hydroxocobalamin meets both of these criteria.

The Street

There is growing evidence that cyanide represents a major toxic component of smoke inhalation victims. Additionally, cyanide is rated as one of the most easily weaponizable toxic agents. Although the U.S. government has placed significant emphasis on cholinergic agents with the provision of Mark I kits and stockpiling of Atropine, little has been done to prepare us for cyanide as a weapon a mass destruction.

To date, the only treatment for cyanide poisoning has been the use of amyl nitrate capsules followed by intravenous sodium nitrate then followed by sodium thiosulfate. These agents have the potential to cause significant hypotension, and their mechanism of action results in the production of methemoglobin, which in the setting of carbon monoxide exposure would cause significant hypoxemia.

Hydroxocobalamin has been proven to be safe and effective. It essentially binds the cyanide ion and is excreted in the urine. The most common side effects are that it turns the patient s skin and urine red, a condition that lasts for four to six days and is otherwise without symptoms. It does cause a moderate rise in blood pressure in non-poisoned volunteers, but it s speculated that this effect would not be seen in cyanide poisoning because cyanide causes hypotension.

Recent studies show that neither EMS nor our hospitals are prepared for mass casualty care of cyanide poisoning. In Paris, because of the concern for cyanide in combination with CO poisoning, all firefighters and fire victims with signs of significant smoke inhalation are given hydroxocobalamin in the field. Their studies show significant improvement in both mortality and morbidity.

I suspect that it won t be long before we adopt this as a standard of care in the U.S.




Connect: Have a thought or feedback about this? Add your comment now
Related Topics: Medical Emergencies, Research

What's Your Take? Comment Now ...

Buyer's Guide Featured Companies

Featured Careers & Jobs in EMS

FEBRUARY 25-28, 2015

Baltimore Convention Center
Baltimore, Maryland USA
THE SHOW IS OPEN!

WEATHER REPORT


 

 

 

 

Get JEMS in Your Inbox

 

Fire EMS Blogs


Blogger Browser

Today's Featured Posts

 

EMS Airway Clinic

Innovation & Advancement

This is the seventh year of the EMS 10 Innovators in EMS program, jointly sponsored by Physio-Control and JEMS.
More >

Multimedia Thumb

Wesleyan Students Hospitalized for Overdose

11 students transported to local hospitals.
Watch It >


Multimedia Thumb

Denver Medic's Family Says Job Stress Contributed to Suicide

Veteran of over 25 years took her own life after a call.
Watch It >


Multimedia Thumb

Denver First Responders Join to Remember Paramedic

Veteran medic took her own life after fatal accident.
Watch It >


Multimedia Thumb

Rigs Going in Service from EMS Today 2015

Snap shots of some of the vehicles at EMS Today that will be on the streets soon
More >


Multimedia Thumb

Florida Hospital Fire

Fire halts construction project at Tampa cancer center.
More >


Multimedia Thumb

The AmbuBus®, Bus Stretcher Conversion Kit - EMS Today 2013

AmbuBus®, Bus Stretcher all-hazards preparedness & response tool
Watch It >


Multimedia Thumb

VividTrac offered by Vivid Medical - EMS Today 2013

VividTrac, affordable high performance video intubation device.
Watch It >


Multimedia Thumb

Field Bridge Xpress ePCR on iPad, Android, Kindle Fire

Sneak peek of customizable run forms & more.
Watch It >


Multimedia Thumb

LMA MAD Nasal™

Needle-free intranasal drug delivery.
Watch It >


More Product Videos >