Hydroxocobalamin is an antidote that seems to have many of the characteristics of the ideal cyanide antidote: rapid onset of action, neutralizes cyanide without interfering with cellular oxygen use, tolerability and safety profiles conducive to prehospital use, safe for use with smoke-inhalation victims, not harmful when administered to non-poisoned patients, easy to administer. Hydroxocobalamin differs from these antidotes in that it has not been associated with clinically significant toxicity in antidotal doses. As per my 1986 memo, Amyl Nitrite continues to require a physician's prescription and the administration of this drug in an emergency situation by the designated first aide. The potential for serious toxicity limits or prevents the use of the Cyanide Antidote Kit, dicobalt edetate, and 4-dimethylaminophenol in prehospital empiric treatment of suspected cyanide poisoning. Cyanide Antidote Kits This memo is in response to your correspondence of April 27, regarding updated information on Cyanide Antidote Kits since my August, 1986 letter. The data available to date do not suggest obvious differences in efficacy among antidotes, with the exception of a slower onset of action of sodium thiosulfate (administered alone) than of the other antidotes. Therapies include sodium thiosulfate (to increase rhodanase activity) sodium nitrite. Each of the antidotes shows evidence of efficacy in animal studies and clinical experience. Antidotes work by dissociating the cyanide ion from cytochrome oxidase. This paper reviews preclinical and clinical data on available cyanide antidotes and considers the profiles of these antidotes relative to properties of a hypothetical ideal cyanide antidote. Critical assessment of cyanide antidotes is needed to aid in therapeutic and administrative decisions that will improve care for victims of cyanide poisoning (particularly poisoning from enclosed-space fire-smoke inhalation), and enhance readiness for cyanide toxic terrorism and other mass-casualty incidents. The international medical community lacks consensus about the antidote or antidotes with the best risk–benefit ratio. Therefore, thiosulfate appears to be the most effective and safest prophylactic agent against cyanide toxicity in dogs.Cyanide has several antidotes, with differing mechanisms of action and diverse toxicological, clinical, and risk–benefit profiles. The cyanide antidote kit produces a high-affinity source of ferric ions (Fe3+) for. Note that several antidotes are available for the treatment of cyanide poisoning, each with differing mechanisms of action and diverse toxicological, clinical and risk-benefit profiles. Step 1: Administer proper first aid containing pure oxygen, amyl nitrate and cardiopulmonary resuscitation. Treatment of cyanide poisoning involves first aid and antidotes. However, nitrite infusion produced high levels of methemoglobin 7.2 +/- 1.1 g/dl, while vitamin B12a infusion and cysteine injection, at the stated doses, did not prevent cyanide-induced circulatory failure. The cyanide antidote kit is an alternative therapy for cyanide toxicity. Since cyanide is known to act rapidly, prompt treatment is to be performed without delay. thiosulfate (30 mg/kg bolus plus 60 mg/kg/h), or vitamin B12a (50 mg/kg bolus plus 100 mg/kg/h). Cyanide poisoning can be treated with rapid oxygen administration and the antidotes sodium nitrite and sodium thiosulfate. Protection against CN administration for the total 150-min period of observation was provided by a bolus injection plus a constant infusion of nitrite (5 mg/kg bolus plus 5 mg/kg/h). A bolus injection of nitrite (5 mg/kg), thiosulfate (150 mg/kg), or cysteine (450 mg/kg) increased the the protection from lethality even further. A low dose of vitamin B12a (100 mg/kg), an infusion of thiosulfate (12 mg/kg/h), or ventilation with 100 per cent O2 increased the amount of CN needed to cause death. Since cyanide is known to act rapidly, prompt treatment is to be performed without delay. 2 mg/kg (mean +/- SE), while the whole-blood CN concentration was 438 +/- 40 micrograms/dl and the gracilis muscle concentration was 2.0 +/. These treatments act on different components of cyanides. The lethal dose in animals whose lungs were ventilated with room air was 2.4 +/-. Presently, there are two widely accepted antidotes: sodium thiosulfate and hydroxocobalamin. Additionally, arterial blood pressure, right ventricular pressure, heart rate, electrocardiogram, blood-gas and pH values, and whole blood and tissue CN concentrations were measured. To test the efficacies of various antidotes to cyanide (CN) poisoning, the lethal dose of cyanide in dogs was estimated during constant infusion of potassium cyanide at a rate of 0.1 mg/kg/min.
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