Cyanide Poisoning

Cyanide Poisoning - Cyanide Poisoning and Its Treatment...

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Cyanide Poisoning and Its Treatment Rebeca Gracia, Pharm.D., and Greene Shepherd, Pharm.D. Cyanide is both widely available and easily accessible throughout the world. Although the compound is not frequently encountered, it has been used as a poison and contaminant in the past and is a potential terrorist agent. Cyanide has the ability to cause significant social disruption and demands special attention to public health preparedness. It can be obtained from a variety of sources, including industrial, medical, and even common household products. Another frequently encountered source of cyanide exposure is residential fires. Exposure to high concentrations of the chemical can result in death within seconds to minutes. Long-term effects from cyanide exposure can cause significant morbidity. The only treatment for cyanide toxicity approved for use in the United States is a kit consisting of amyl nitrite, sodium nitrite, and sodium thiosulfate. Future research aims to find a faster-acting, more effective, and better tolerated treatment for cyanide toxicity. Key Words: cyanide, antidote, poisoning. (Pharmacotherapy 2004;24(10):1358–1365) OUTLINE Sources Toxic Dose and Onset of Toxicity Mechanism of Toxicity Acute Clinical Manifestations Treatment Antidote Therapy Investigational and Non–U.S.-Approved Antidotes and Prophylaxis Conclusion Cyanide was used as a poison for centuries before the chemical was isolated and identified. 1, 2 Many, and often successful, attempts have been made throughout history to exploit it as a poison and contaminant against individuals as well as targeted populations. Recent events have height- ened concern about the use of chemical weapons by terrorists. In addition to being highly toxic, cyanide exposure can cause significant social disruption and public panic. This threat demands special attention to public health preparedness (e.g., antidote stocking). The only treatment for cyanide toxicity approved for use in the United States is a kit consisting of amyl nitrite, sodium nitrite, and sodium thiosulfate (Cyanide Antidote Kit; Acorn Inc., Buffalo Grove, IL). It was formerly known as the Pasadena or Lilly Kit. It is important for health professionals to be aware of potential sources of cyanide, its effects and treatment, and investigational as well as non–U.S.-approved antidotes. Sources Cyanide is both widely available and easily accessible in a variety of forms. Historically, cyanide was used as a warfare agent in the volatile, water-soluble, liquid forms of hydrogen cyanide and cyanogen chloride. The highly reactive salt forms are exploited for numerous industrial applications, including chemical synthesis, electroplating, tanning, metallurgy, printing, agriculture, photography, manufacture of paper and plastics, and for use as fumigants and insecticides. These salts produce hydrogen cyanide gas when mixed with strong acid and thus pose a significant risk in industrial accidents as well as for intentional exposures. The
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Cyanide Poisoning - Cyanide Poisoning and Its Treatment...

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