Cyanide poisoning by fire smoke inhalation

AbstractThe contribution of smoke inhalation to cyanide-attributed morbidity and mortality arguably surpasses all other sources of acute cyanide poisoning. Research establishes that cyanide exposure is: (1) to be expected in those exposed to smoke in closed-space fires; (2) cyanide poisoning is an important cause of incapacitation and death in smoke-inhalation victims; and (3) that cyanide can act independently of, and perhaps synergistically with, carbon monoxide to cause morbidity and mortality. Effective prehospital management of smoke inhalation-associated cyanide poisoning is inhibited by: (1) a lack of awareness of fire smoke as an important cause of cyanide toxicity; (2) the absence of a rapidly returnable diagnostic test to facilitate its recognition; and (3) in the United States, the current unavailability of a cyanide antidote that can be used empirically with confidence outside of hospitals. Addressing the challenges of the prehospital management of smoke inhalation-associated cyanide poisoning entails: (1) enhancing the awareness of the problem among prehospital responders; (2) improving the ability to recognize cyanide poisoning on the basis of signs and symptoms; and (3) expanding the treatment options that are useful in the prehospital setting.

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Intraosseous administration of hydroxocobalamin after enclosed structure fire cardiac arrest

BMJ Case Reports ◽

10.1136/bcr-2020-239523 ◽

2021 ◽

Vol 14 (3) ◽

pp. e239523

Author(s):

Joshua Mastenbrook ◽

Rachel Zamihovsky ◽

Nathan Brunken ◽

Thomas Olsen

Keyword(s):

Cardiac Arrest ◽

Circulatory System ◽

Neurological Status ◽

Human Case ◽

Spontaneous Circulation ◽

Smoke Inhalation ◽

Cyanide Poisoning ◽

Hospital Arrival ◽

Marrow Cavity ◽

Developed World

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.

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Fire smoke inhalation in pregnancy

Journal of Obstetrics and Gynaecology ◽

10.1080/01443610701467218 ◽

2007 ◽

Vol 27 (5) ◽

pp. 525-526

Author(s):

S. Gopu ◽

H. Y. Wan Hussein ◽

S. Ray

Keyword(s):

Smoke Inhalation ◽

Fire Smoke ◽

In Pregnancy

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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.

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Health Impacts of Fire Smoke Inhalation

Inhalation Toxicology ◽

10.1080/08958370801975311 ◽

2008 ◽

Vol 20 (8) ◽

pp. 761-766 ◽

Cited By ~ 53

Author(s):

M. Stefanidou ◽

S. Athanaselis ◽

C. Spiliopoulou

Keyword(s):

Smoke Inhalation ◽

Health Impacts ◽

Fire Smoke

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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

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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.

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