Medical treatment cyanide poisoning

Patients who are critical and do not satisfactorily respond to supportive therapy should be administered specific cyanide antidotes as outlined in Table 19.5. Cyanide antidotes have been classified into three main groups based on their mechanism of action (1) methemoglobin inducers, (2) sulfur donors, and (3) cobalt compounds. The definitive treatment of cyanide poisoning differs in various countries due to different medical practices and guidelines. The safety... 

Or in other more bizarre ways. A 23-year-old medical student saw his dog (a puppy) suddenly collapse. He started external cardiac massage and a mouth-to-nose ventilation effort. Moments later the dog died, and the student felt nauseated, vomited and lost consciousness. On the victim s arrival at hospital, an alert medical officer detected a bitter almonds odour on his breath and administered the accepted treatment for cyanide poisoning after which he recovered. It turned out that the dog had accidentally swallowed cyanide, and the poison eliminated through the limgs had been inhaled by the master during the mouth-to-nose resuscitation. Journal of the American Medical Association 1983 249 353. 

Possibly the most important elements of therapy are general supportive actions, which, by themselves, can effect the recovery of most casualties without further risk from specific antidotal therapy.41 They are probably the only indicated therapies for casualties of cyanide poisoning who arrive conscious at the emergency medical treatment station. 

Cyanide poisoning is treated with specific antidotes and supportive medical care in a hospital setting. The most important thing is tor victims to seek medical treatment as soon as possible. 

Poison Treatment As discussed previously, methemoglobin binds well and competes with cytochrome oxidase for cyanide ions. Consequently, the antidote developed for cyanide poisoning involves increasing the formation of methemoglobin in the blood, by inhalation of amyl nitrate vapor (Chen 1952). Antidote kits contain amyl nitrate ampoules. To administer the antidote, the ampoule is broken in a cloth such as a handkerchief and held close to the victim s nose while artificial respiration is being conducted. Resuscitation by mouth is not recommended a mechanical resuscitator should be used instead. If the victim does not respond to the amyl nitrate treatment, a medical professional would then increase the methemoglobin production by intravenous injection of sodium nitrate followed by administration of thiosulfate to increase the activity of the rhodanese enzyme. 

For an accident involving ingestion of cyanides, administer one pint of 1 percent sodium thiosulfate, and then induce vomiting with soapy water or mustard water. Refer to standard ffist aid manuals for methods of inducing vomiting. It is urgent that all cyanide poisoning cases receive immediate medical treatment. 

Ellenhorn, M.J., Schonwald,., Ordog, G., et al., 1997. Cyanide poisoning. In Ellenhorn, M.J., Schonwald,., Ordog, G., Wasserberger, J. (Eds.), Ellenhorn s Medical Toxicology Diagnosis and Treatment of Human Poisoning, second ed. Williams Wilkins, Baltimore, MD, pp. 1476-1484. 

This section will describe clinical practice and research concerning methods for reducing toxic effects of exposure to cyanide. However, because some of the treatments discussed may be experimental and unproven, this section should not be used as a guide for treatment of exposures to cyanide. When specific exposures have occurred, poison control centers and medical toxicologists should be consulted for medical advice. The following texts provide specific information about treatment following exposures to cyanide ... 

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