Toxic smoke inhalation and cyanide poisoning

Smoke inhalation is the most common cause of acute cyanide poisoning in the developed world. Hydroxocobalamin is an antidote for cyanide poisoning. There is little published about human intraosseous antidote administration. We present a case of intraosseous hydroxocobalamin administration in an adult smoke inhalation victim, found in cardiac arrest inside her burning manufactured home. Return of spontaneous circulation was achieved after 20 min of cardiopulmonary resuscitation. Five grams of hydroxocobalamin were subsequently given intraosseously. On hospital arrival, patient was found to have a respiratory-metabolic acidosis. She had red-coloured urine without haematuria, a known sequela of hydroxocobalamin administration. Patient’s neurological status deteriorated, and she died 4 days after admission. This case highlights that intraosseously administered hydroxocobalamin seems to adequately flow into the marrow cavity and enter the circulatory system despite the non-compressible glass antidote vial. This appears to be only the second reported human case of intraosseous hydroxocobalamin administration.

Download Full-text

Is There An Ideal Prehospital Drug Treatment For Acute Cyanide Poisoning?

Australasian Journal of Paramedicine ◽

10.33151/ajp.12.3.232 ◽

2015 ◽

Vol 12 (3) ◽

Author(s):

Craig B Barraclough

Keyword(s):

Carbon Monoxide ◽

Drug Treatment ◽

Sodium Nitrite ◽

Keyword Search ◽

Haemodynamic Effects ◽

Smoke Inhalation ◽

Cyanide Poisoning ◽

Sodium Thiosulphate ◽

Negative Effects ◽

Amyl Nitrite

IntroductionCyanide, due to its toxicity and prevalence in a variety of industries, is a suitable agent for terrorists or disaffected persons to use as a weapon of terror. New Zealand’s National Poisons Centre lists five cyanide antidotes. This review aimed to identify whether there is an ideal pre-hospital drug treatment for acute cyanide poisoning.MethodsLiterature less than 10 years old was selected after a keyword search. The articles were reviewed for specific positive and negative properties of each antidote.ResultsThirty-nine articles were reviewed of which four were excluded. Results varied, with hydroxocobalamin scoring highly on effectiveness, with limited negative effects. It also demonstrated positive haemodynamic effects, suitability in cases involving trauma, carbon monoxide (CO), smoke inhalation casualties and was safe for pre-hospital use. Sodium nitrite, followed by dicobalt edetate had the next highest scores for efficacy. However, both scored negatively for their effects on blood, causing hypotension and toxicity, and they are unsuitable for trauma, CO or smoke inhalation casualties. Sodium thiosulphate, with a moderate level of efficiency, remained most effective when co-administered with other antidotes. 4-dimethylaminophenol and amyl nitrite rated the lowest, with negative effects similar to sodium nitrite. Adrenaline was tested as an antidote in one study where two novel antidotes both demonstrated promising results.ConclusionHydroxocobalamin had the highest success rate and its safety profile make it the most suitable pre-hospital drug treatment for acute cyanide poisoning.

Download Full-text

A case of cyanide poisoning complicated with carbon monoxide poisoning caused by smoke inhalation

Nihon Kyukyu Igakukai Zasshi ◽

10.3893/jjaam.25.797 ◽

2014 ◽

Vol 25 (10) ◽

pp. 797-803

Author(s):

Yasumasa Iwasaki ◽

Akira Narame ◽

Kazunobu Une ◽

Kohei Ota ◽

Yoshiko Kida ◽

...

Keyword(s):

Carbon Monoxide ◽

Carbon Monoxide Poisoning ◽

Smoke Inhalation ◽

Cyanide Poisoning

Download Full-text

Toxic inhalational injury

BMJ Case Reports ◽

10.1136/bcr-2019-232875 ◽

2020 ◽

Vol 13 (3) ◽

pp. e232875 ◽

Cited By ~ 1

Author(s):

Victoria Davies ◽

Jake Turner ◽

Michael Greenway

Keyword(s):

Blood Gas Analysis ◽

Cardiovascular Effects ◽

Gas Analysis ◽

Smoke Inhalation ◽

Cyanide Poisoning ◽

First Line ◽

Early Administration ◽

Cyanide Antidote ◽

Inhalational Injury ◽

Haemoglobin Testing

A middle-aged patient presented with toxic inhalational injury, and was resuscitated prehospitally and treated in the emergency department for smoke inhalation, carbon monoxide (CO) exposure and cyanide poisoning with the use of antidotes. Due to the CO effects on spectrophotometry, an anaemia initially identified on blood gas analysis was thought to be artefactual, but was later confirmed by laboratory testing to be accurate. In addition, cyanide can confound haemoglobin testing due to its use in the analytical process and non-cyanide analysis is required when there is suspected exposure. Although no consensus exists on a first-line cyanide antidote choice, hydroxocobalamin is the only antidote without a serious side effect profile and/or deleterious cardiovascular effects. We propose prehospital enhanced care teams consider carrying hydroxocobalamin for early administration in toxic inhalational injury.

Download Full-text

Where There Is Smoke… Inhalation Injuries, Carbon Monoxide, and Cyanide Poisoning

Advanced Emergency Nursing Journal ◽

10.1097/01.tme.0000319928.43215.29 ◽

2008 ◽

Vol 30 (2) ◽

pp. 180-187 ◽

Cited By ~ 2

Author(s):

Michael Sahjian ◽

Michael A. Frakes

Keyword(s):

Carbon Monoxide ◽

Smoke Inhalation ◽

Cyanide Poisoning

Download Full-text

Role of Hydroxocobalamin in Acute Cyanide Poisoning

Annals of Pharmacotherapy ◽

10.1345/aph.1k559 ◽

2008 ◽

Vol 42 (5) ◽

pp. 661-669 ◽

Cited By ~ 56

Author(s):

Greene Shepherd ◽

Larissa I Velez

Keyword(s):

Safety Profile ◽

Data Extraction ◽

Preclinical Study ◽

Current Data ◽

Human Studies ◽

Smoke Inhalation ◽

Cyanide Poisoning ◽

Mesh Terms ◽

Study Selection ◽

Cyanide Antidote

Objective: To review the recently approved cyanide antidote, hydroxocobalamin, and describe its role in therapy. Data Sources: Relevant publications were identified through a systematic search of PubMed using the MeSH terms and key words hydroxocobalamin and cyanide. This search was then limited to human studies published since 2000. Systematic searches were conducted through January 2008. References from identified articles were reviewed for additional pertinent human studies. Study Selection and Data Extraction: The literature search retrieved 7 studies on the safety and/or efficacy of hydroxocobalamin in humans. Four new studies were identified by the search and 3 studies were identified from the references. Data Synthesis: Studies of antidote efficacy in humans are ethically and logistically difficult. A preclinical study demonstrated that intravenous doses of hydroxocobalamin 5 g are well tolerated by volunteer subjects. Hydroxocobalamin has been shown to reduce cyanide concentrations in controlled studies of nitroprusside therapy and in heavy smokers. A retrospective study of 14 acute cyanide poisonings also demonstrated hydroxocobalamin's safety and efficacy. Two studies examining hydroxocobalamin for smoke inhalation-associated cyanide poisoning indicated a possible benefit, but they are insufficient to establish definitive criteria for use in this setting. Randomized controlled trials of hydroxocobalamin and traditional cyanide antidotes (nitrites/thiosulfate) are lacking. Conclusions: Cyanide poisoning can rapidly cause death. Having an effective antidote readily available is essential for facilities that provide emergency care. In cases of cyanide ingestion, both the nitrite/thiosulfate combination and hydroxocobalamin are effective antidotes. Hydroxocobalamin offers an improved safety profile lor children and pregnant women. Hydroxocobalamin also appears to have a better safety profile in the setting of cyanide poisoning in conjunction with smoke inhalation. However, current data are insufficient to recommend the empiric administration of hydroxocobalamin to all victims of smoke inhalation.

Download Full-text