Cyanide and methemoglobin kinetics in smoke inhalation victims treated with the cyanide antidote kit.
OBJECTIVE
To evaluate serial cyanide, methemoglobin, and carbon monoxide levels in smoke inhalation patients.


METHODS
Regional poison center and regional toxicology treatment center.


METHODS
Seven critically ill smoke inhalation patients referred to the regional poison center.


METHODS
Peak level and half-life were determined by obtaining serial carboxyhemoglobin, cyanide, and methemoglobin levels.


RESULTS
The mean observed half-life of cyanide was 3.0 +/- 0.6 hours. Methemoglobinemia was evaluated in four patients after sodium nitrite administration. The peak measured methemoglobin levels (mean, 10.5% +/- 2%; range, 7.9% to 13.4%) did not occur until a mean of 50 minutes (range, 35 to 70 minutes) following administration of sodium nitrite. The total oxygen-carrying capacity reduced by the combination of carboxyhemoglobin and methemoglobin was never more than 21% (range, 10% to 21%) in this series.


CONCLUSIONS
The administration of sodium nitrite to smoke inhalation patients in the presence of concomitant carbon monoxide poisoning may be relatively safe.
Kirk
M A
MA
Rocky Mountain Poison Center, Denver, Colorado.
Gerace
R
R
Kulig
K W
KW
D000328:Adult; D000931:Antidotes / Q000494:pharmacology / Q000627:therapeutic use*; D002249:Carbon Monoxide Poisoning / Q000150:complications*; D002263:Carboxyhemoglobin / Q000032:analysis* / Q000493:pharmacokinetics; D003131:Combined Modality Therapy; D003486:Cyanides / Q000097:blood* / Q000493:pharmacokinetics / Q000506:poisoning*; D004341:Drug Evaluation; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation; D007262:Infusions, Intravenous; D008297:Male; D008706:Methemoglobin / Q000493:pharmacokinetics; D008708:Methemoglobinemia / Q000097:blood* / Q000150:complications; D008875:Middle Aged; D011039:Poison Control Centers; D011041:Poisoning / Q000097:blood / Q000150:complications / Q000188:drug therapy; D011446:Prospective Studies; D015208:Smoke Inhalation Injury / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D012977:Sodium Nitrite / Q000494:pharmacology / Q000627:therapeutic use*; D013885:Thiosulfates / Q000494:pharmacology / Q000627:therapeutic use*; D013997:Time Factors
D000931:Antidotes; D003486:Cyanides; D013885:Thiosulfates; D008706:Methemoglobin; D002263:Carboxyhemoglobin; C017717:sodium thiosulfate; D012977:Sodium Nitrite