![]() Cyanide toxicity must be treated with an antidote - sodium thiosulfate, sodium nitrite, and hydroxocobalamin.4 Each of the antidotes works by binding with the highly reactive cyanide, neutralizing the compound, and converting it into a water-soluble product that will be cleared through renal excretion.4Fire victims often present to the emergency department critically ill. However, symptoms of cyanide toxicity cannot be treated with supplemental oxygen as carbon monoxide and carbon dioxide are. Ultimately, the body will suffer cardiorespiratory arrest.1Symptoms of cyanide toxicity include headache, nausea, shortness of breath, and altered mental status.1 These are similar to those of carbon monoxide and carbon dioxide inhalation. Anaerobic metabolism results in the production of lactic acid, which causes metabolic acidosis.3 The human body cannot sustain itself with the lack of oxygen and anaerobic metabolism for a prolonged period of time. ![]() Hydrogen cyanide is especially dangerous to humans because the gaseous form reacts quickly upon inhalation.2When cyanide enters the body via inhalation, it blocks the cells from utilizing oxygen by binding to the cytochrome oxidase in the mitochondria.2 The inability of the cell to use oxygen forces cells from aerobic metabolism into anaerobic metabolism. However, modern synthetic materials such as plastics, papers, textiles, and machinery can release a much greater concentration of hydrogen cyanide when exposed to high temperatures.1 As the use of contemporary nitrogen-containing synthetic polymers has expanded, the possibility of cyanide toxicity has become increasingly common and severe. It is present within many different types of plants and fruits including apricots, apples, peaches, lima beans, and cassava plants but is harmless.1 The trace amounts of cyanide found within organic materials is of little concern because its high reactivity causes it to be metabolized rapidly and create other compounds. ![]() Make sure any doctor caring for your pregnancy or your baby knows you have received this medication.The goal of this simulation is to educate emergency medicine students, residents, attending physicians, and mid-level practitioners to recognize, diagnose, and manage acute cyanide toxicity.Ĭyanide has an almond scent and is a naturally occurring compound. In an emergency situation, it may not be possible before you are treated with hydroxocobalamin to tell your caregivers if you are pregnant or breast feeding. You should not breast-feed after you have been treated with hydroxocobalamin. It is not known whether hydroxocobalamin passes into breast milk or if it could harm a nursing baby. However, the benefits of treating cyanide poisoning may outweigh any risks posed by hydroxocobalamin, for both you and your baby. It is not known whether hydroxocobalamin will harm an unborn baby. ![]() If you have ever had a severe allergic reaction to hydroxocobalamin, Vitamin B12, or cyanocobalamin ( Nascobal, Cobolin, Cyomin, and others).įDA pregnancy category C. Kidney disease (or if you are on dialysis) or If possible before you receive hydroxocobalamin, tell your caregivers if you have: You may report side effects to FDA at 1-80. Call your doctor for medical advice about side effects. This is not a complete list of side effects and others may occur. Pain, swelling, or irritation of your skin where the injection was given. Red coloring of your urine (may last 2 to 5 weeks) or Severe shortness of breath, wheezing, gasping for breath, cough with foamy mucus Ī light-headed feeling, like you might pass out orĭangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure).Ĭommon side effects of Hydroxocobalamin may include: Call your doctor if you have a rash that lasts longer than 4 weeks.Ĭall your doctor at once if you have a serious side effect such as: This rash should go away without treatment. You may develop an acne-like skin rash within 1 to 4 weeks after you are treated with hydroxocobalamin. Get emergency medical help if you have any of these signs of an allergic reaction: hives chest tightness, difficulty breathing swelling of your face, lips, tongue, or throat.
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