title: Early administration of isosorbide dinitrate improves survival of cyanide-poisoned rabbits.
abstract: BACKGROUND
  More effective, rapidly delivered, safer antidotes are needed for cyanide poisoning. Previous study has demonstrated a beneficial effect of isosorbide dinitrate on the survival of cyanide-poisoned mice.
  
  
  OBJECTIVE
  To evaluate the effectiveness of isosorbide dinitrate compared with that of sodium nitrite in cyanide poisoning.
  
  
  METHODS
  A comparative animal study was performed using 18 rabbits, randomized into 3 study groups. Animals were poisoned intravenously with potassium cyanide (1 mg/kg). The first group was not given any further treatment. The second and third groups were treated intravenously 1 min after poisoning with sodium nitrite (6 mg/kg) and isosorbide dinitrate (50 μg/kg), respectively. The primary outcome was short-term survival of up to 30 min. Secondary outcomes included time to death, a clinical score, mean blood pressure, pulse, blood pH, and lactate and methemoglobin levels.
  
  
  RESULTS
  Rabbits treated with isosorbide dinitrate or sodium nitrite survived while only one untreated rabbit survived. Median time to death of the 5 poisoned and untreated animals was 10 min. All the animals collapsed soon after poisoning, exhibiting rapidly disturbed vital signs and developed lactic metabolic acidosis; average peak blood lactate levels were 15.5-19.1 mmol/L at 10 min after poisoning. The treated animals improved gradually with practically full recovery of the clinical scores, vital signs, and blood gas levels. Sodium nitrite administration raised methemoglobin to an average peak of 7.9%, while isosorbide dinitrate did not change methemoglobin levels.
  
  
  CONCLUSIONS
  Early administration of isosorbide dinitrate improved the short-term survival of cyanide-poisoned rabbits. Isosorbide dinitrate shows potential as an antidote for cyanide poisoning and may exert its effect using a nitric-oxide-dependent mechanism.
authors.affiliation: Clinical Pharmacology and Toxicology Unit, Carmel Medical Center , Haifa , Israel.
authors.forename: Ophir
authors.initials: O
authors.lastname: Lavon
mesh_terms: D000138:Acidosis / Q000139:chemically induced / Q000188:drug therapy; D061605:Administration, Intravenous; D000818:Animals; D007548:Isosorbide Dinitrate / Q000494:pharmacology*; D008297:Male; D008706:Methemoglobin / Q000378:metabolism; D011041:Poisoning / Q000188:drug therapy*; D011190:Potassium Cyanide / Q000506:poisoning*; D011817:Rabbits; D012977:Sodium Nitrite / Q000506:poisoning
chemical_list: D008706:Methemoglobin; D007548:Isosorbide Dinitrate; D012977:Sodium Nitrite; D011190:Potassium Cyanide
keywords: Cyanide; Isosorbide dinitrate; Nitrate; Poisoning; Sodium nitrite