Acute cyanide intoxication treated with a combination of hydroxycobalamin, sodium nitrite, and sodium thiosulfate.
An 80-year-old diabetic patient was admitted to the hospital because of sudden unconsciousness and severe metabolic acidosis. His son reported the possibility of cyanide poisoning. Clinical data and the detection of cyanide in blood and gastric material confirmed this possibility. Supportive therapy and the following antidotes--sodium nitrite two doses 300 mg i.v., sodium thiosulfate 3 g i.v., and hydroxocobalamin 4 g in 24 hours--were administered immediately and the patient completely recovered in 48 hours. Our observations suggest that timely and appropriate use of antidotes for cyanide intoxication may prevent death, even in aged diabetic patients.
Department of Preclinical and Clinical Pharmacology, University of Florence, Italy.
Guido
G
Mannaioni
Alfredo
A
Vannacci
Cosimo
C
Marzocca
Anna Monica
AM
Zorn
Sandro
S
Peruzzi
Flavio
F
Moroni
D000138:Acidosis / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D000931:Antidotes / Q000627:therapeutic use*; D003486:Cyanides / Q000097:blood / Q000506:poisoning*; D006397:Hematinics / Q000627:therapeutic use; D006801:Humans; D006879:Hydroxocobalamin / Q000627:therapeutic use*; D007202:Indicators and Reagents / Q000627:therapeutic use; D008297:Male; D012977:Sodium Nitrite / Q000627:therapeutic use*; D013885:Thiosulfates / Q000627:therapeutic use*; D016896:Treatment Outcome
D000931:Antidotes; D003486:Cyanides; D006397:Hematinics; D007202:Indicators and Reagents; D013885:Thiosulfates; C017717:sodium thiosulfate; D012977:Sodium Nitrite; D006879:Hydroxocobalamin