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Deaths Due to Asphyxiant Gases
Published in Sudhir K. Gupta, Forensic Pathology of Asphyxial Deaths, 2022
Apart from antidote kit nowadays hydroxocobalamin has been gradually expanding recognition in treatment because of its safety and effectiveness. Cyanide has a greater affinity to bind with hydroxocobalamin rather than cytochrome oxidase a3 forming cyanocobalamin.16 Hydroxocobalamin can decrease mortality with less severe associated side effects with no neurological sequelae. Its freeze-dried preparation available and named as Cyanokit.17
Toxicology
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Call for immediate senior ED doctor help, and/or advice from a clinical toxicologist if time allows. Give the following: Hydroxocobalamin 70 mg/kg up to 5 g i.v. over 30 min or as a bolus in critical cases. Although unlicensed, it is preferred to dicobalt edetate.Plus 25% sodium thiosulphate 12.5 g (50 mL) i.v. at a rate of 2–5 mL/min. Do not mix in the same infusion as the hydroxocobalamin.Repeat the above within 15 min, if there is no or only partial improvement.
Cobalamin C, D, F, G diseases; methylmalonic aciduria and variable homocystinuria
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop
Among three patients with neonatal hemolytic uremic syndrome patients with Cbl C disease, treatment with parenteral hydroxocobalamin, folic acid, and betaine reduced biochemical abnormalities to normal levels [32]. There has been little consensus of the optimal dose of hydroxocobalamin beyond infancy; most infants are treated with 1 mg daily, with some reduced to less than daily use after infancy. Increasing parenteral hydroxocobalamin to 5 mg daily was required in two patients for clinical and metabolic control of thrombotic microangiopathy [46]. Others have recommended doses of 20 to 25 mg [44]. Better outcome after dose escalation has been reported [47–49]. Doses ranged from 0.11 to 0.36 mg/kg/24 hours.
Life-Threatening Cyanide Intoxication after Ingestion of Amygdalin in Prehospital Care
Published in Prehospital Emergency Care, 2022
Patrik Cmorej, Petr Bruthans, Jaroslav Halamka, Irena Voriskova, David Peran
The diagnosis of amygdalin intoxication in prehospital emergency care is complicated by the fact that the patient’s clinical picture may be confused with another diagnosis, such as epilepsy, stroke, etc. An important aspect in diagnosis is obtaining anamnestic data on the use of amygdalin, which may help reveal cyanide intoxication. The patient had a bitter tonsil odor, which is described in cyanide intoxication. Cyanide intoxication leads to the development of lactic acidosis, the finding of which at the emergency department should lead to a review of the patient’s medications, including complementary and alternative drugs (2). A specific therapy for cyanide poisoning is the administration of an antidote. In the presented case report, hydroxocobalamin (Cyanokit) was used, the effect of which is based on the ability to firmly bind cyanide ions. Each hydroxocobalamin molecule can bind one cyanide ion by substituting a hydroxy-ligand bound to a trivalent cobalt ion to form a cyanocobalamin complex. Cyanocobalamin is a stable, nontoxic compound that is excreted in urine. Due to the favorable safety and efficacy profile, hydroxocobalamin has been proposed as an antidote for cyanide poisoning and hydroxocobalamin (Cyanokit) was approved by the FDA in 2006 (7). The availability of hydroxocobalamin in prehospital emergency care depends on local conditions. It is often applied in the hospital. Treatment is symptomatic when hydroxocobalamin is not available in prehospital emergency care.
DMTS is an effective treatment in both inhalation and injection models for cyanide poisoning using unanesthetized mice
Published in Clinical Toxicology, 2018
Susan M. DeLeon, Jason D. Downey, Diane M. Hildenberger, Melissa O. Rhoomes, Lamont Booker, Gary A. Rockwood, Kelly A. Basi
The currently available treatments in the U.S. for CN poisoning are the combination of sodium nitrite and sodium thiosulfate (Nithiodote®) and hydroxocobalamin (Cyanokit®). Sodium nitrite is a methemoglobin inducer, which has a higher affinity for CN than the ferric iron of cytochrome oxidase a3. However, emerging evidence suggests that sodium nitrite may be acting through additional mechanisms [3,26,27]. Sodium thiosulfate works as an antidote in CN poisoning by acting as a donor of sulfane sulfur, in which endogenous sulfurtransferase enzymes, most importantly rhodanese, combine with CN to form thiocyanate. Furthermore, hydroxocobalamin is a cobalt-based direct CN-chelating antidote. All three agents are administered by intravenous injection, which has limited application in mass casualty situations. An ideal CN antidote for a mass casualty situation would be capable of rapid administration in small volumes via an autoinjector, by intraosseous injection, or by inhalation [28].
Healthcare providers’ attitude and knowledge regarding medication use in breastfeeding women: a Jordanian national questionnaire study
Published in Journal of Obstetrics and Gynaecology, 2018
Nour A. Al-Sawalha, Abeer Sawalha, Linda Tahaineh, Basima Almomani, Maha Al-Keilani
The knowledge of participants was assessed by investigating their answers for different questions that covered the commonly used medications by breastfeeding women such as analgesics, antibiotics, gastrointestinal, cardiovascular and antidiabetic medications (Al-Sawalha et al. 2016). Out of the 904 participants, only 179 HCPs (19.8%) had good knowledge. Less than half of the HCPs agreed that acetylsalicylic acid was compatible with breastfeeding and monitoring the breastfed child was necessary. Most participated HCPs agreed that amoxicillin plus clavulanic acid, ferrous salt, folic acid and hydroxocobalamin were safe to be given during breastfeeding. However, less than half of the HCPs in the current study stated that ethinylestradiol plus levonorgestrel combination was better to be avoided during breastfeeding.