Document Detail


Prospective study of hydroxocobalamin for acute cyanide poisoning in smoke inhalation.
MedLine Citation:
PMID:  17481777     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY OBJECTIVE: To assess outcomes in patients treated with hydroxocobalamin at the fire scene or in the ICU for suspected smoke inhalation-associated cyanide poisoning. METHODS: Adult smoke inhalation victims with suspected cyanide poisoning as determined by soot in the face, mouth, or nose or expectorations and neurologic impairment received an intravenous infusion of hydroxocobalamin 5 g (maximum 15 g) at the fire scene or in the ICU in this observational case series conducted from 1987 to 1994. Blood cyanide specimens were collected before administration of hydroxocobalamin. The threshold for cyanide toxicity was predefined as greater than or equal to 39 micromol/L. RESULTS: The sample included 69 patients (mean age 49.6 years; 33 men), of whom 39 were comatose. Out-of-hospital deaths were excluded. Fifty of the 69 patients (72%) admitted to the ICU survived after administration of hydroxocobalamin. In the group in which cyanide poisoning was confirmed a posteriori (n=42), 67% (28/42) survived after administration of hydroxocobalamin. The most common adverse events were chromaturia (n=6), pink or red skin discoloration (n=4), hypertension (n=3), erythema (n=2), and increased blood pressure (n=2). No serious adverse events were attributed to hydroxocobalamin. Laboratory tests revealed transient alterations in renal and hepatic function consistent with the critical condition of the patients and mild anemia consistent with progressive hemodilution. CONCLUSION: Empiric administration of hydroxocobalamin was associated with survival among 67% of patients confirmed a posteriori to have had cyanide poisoning. Hydroxocobalamin was well tolerated irrespective of the presence of cyanide poisoning. Hydroxocobalamin appears to be safe for the out-of-hospital treatment of presumptive cyanide poisoning from smoke inhalation.
Authors:
Stephen W Borron; Frédéric J Baud; Patrick Barriot; Michel Imbert; Chantal Bismuth
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-05-04
Journal Detail:
Title:  Annals of emergency medicine     Volume:  49     ISSN:  1097-6760     ISO Abbreviation:  Ann Emerg Med     Publication Date:  2007 Jun 
Date Detail:
Created Date:  2007-05-21     Completed Date:  2007-06-14     Revised Date:  2008-01-17    
Medline Journal Info:
Nlm Unique ID:  8002646     Medline TA:  Ann Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  794-801, 801.e1-2     Citation Subset:  AIM; IM    
Affiliation:
Division of Emergency Medicine, University of Texas Health Science Center, San Antonio, TX, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Antidotes / adverse effects,  therapeutic use*
Emergency Medical Services
Female
Fires
Humans
Hydrogen Cyanide / blood,  poisoning*
Hydroxocobalamin / adverse effects,  therapeutic use*
Male
Middle Aged
Prospective Studies
Smoke Inhalation Injury / blood,  drug therapy*,  mortality
Survival Rate
Vitamin B Complex / adverse effects,  therapeutic use*
Chemical
Reg. No./Substance:
0/Antidotes; 12001-76-2/Vitamin B Complex; 13422-51-0/Hydroxocobalamin; 74-90-8/Hydrogen Cyanide
Comments/Corrections
Comment In:
Ann Emerg Med. 2007 Jun;49(6):814-6   [PMID:  17512866 ]
Ann Emerg Med. 2008 Jan;51(1):108; author reply 108-9   [PMID:  18166440 ]

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