title: Successful Use of Hydroxocobalamin and Sodium Thiosulfate in Acute Cyanide Poisoning: A Case Report with Follow-up.
abstract: Hydroxocobalamin is an effective first-line antidote used mainly in monotherapy of cyanide poisonings, while the opinions are different on the effects of its combination with sodium thiosulfate. A 58-year-old male committed a suicide attempt by ingesting of 1200-1500 mg of potassium cyanide; he was unconscious for 1-1.5 min. after ingestion with the episode of generalized seizures. On admission to the ICU, the patient was acidotic (pH 7.28; HCO3 14.0 mmol/L, base excess -12.7 mmol/L, saturation O2 0.999) with high serum lactate (12.5 mmol/L). Hydroxocobalamin was administered 1.5 hr after ingestion in two subsequent intravenous infusions at a total dose of 7.5 g. The infusion was followed by continuous intravenous administration of 1 mL/hr/kg of 10% sodium thiosulfate at a total dose of 12 g. No complications and adverse reactions were registered. Serum lactate decreased to 0.6 mmol/L the same day, and arterial blood gases became normal (pH 7.49; HCO3 27.2 mmol/L, base excess 2.2 mmol/L, saturation O2 0.994). The follow-up examination 5 months later revealed no damage of basal ganglia and cerebellum on magnetic resonance imaging. The neurological examination revealed no pathological findings. On the ocular coherence tomography, the retinal nerve fibres layer was normal. In visual evoked potentials, there was a normal evoked complex on the left eye and minor decrease in amplitude on the right eye. Combination of hydroxocobalamin and sodium thiosulfate can have a positive effect on the survival without long-term neurological and visual sequelae in the cases of massive cyanide poisonings due to the possibility of a potentiation or synergism of hydroxocobalamin effects by sodium thiosulfate. This synergism can be explained by the different time-points of action of two antidotes: the initial and immediate effect of hydroxocobalamin, followed by the delayed, but more persistent effect of sodium thiosulfate.
authors: Department of Occupational Medicine, Toxicological Information Centre, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
authors: Sergey
authors: S
authors: Zakharov
authors: Department of Radiodiagnostics, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
authors: Manuela
authors: M
authors: Vaneckova
authors: Department of Radiodiagnostics, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
authors: Zdenek
authors: Z
authors: Seidl
authors: Department of Ophthalmology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
authors: Pavel
authors: P
authors: Diblik
authors: Department of Ophthalmology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
authors: Pavel
authors: P
authors: Kuthan
authors: Department of Occupational Medicine, Toxicological Information Centre, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.|National Institute of Public Health, Prague, Czech Republic.
authors: Pavel
authors: P
authors: Urban
authors: Department of Biomimetic Electrochemistry, J. Heyrovský Institute of Physical Chemistry of the AS CR, v.v.i, Prague, Czech Republic.|First Faculty of Medicine, Institute of Medical Biochemistry and Laboratory Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
authors: Tomas
authors: T
authors: Navratil
authors: Department of Occupational Medicine, Toxicological Information Centre, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
authors: Daniela
authors: D
authors: Pelclova
mesh_terms: D000931:Antidotes / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D006879:Hydroxocobalamin / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011190:Potassium Cyanide / Q000506:poisoning*; D013406:Suicide, Attempted; D013885:Thiosulfates / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000931:Antidotes; D013885:Thiosulfates; C017717:sodium thiosulfate; D011190:Potassium Cyanide; D006879:Hydroxocobalamin