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Suzuki Y, Taguchi K, Kure T, Sakai H, Enoki Y, Otagiri M, Matsumoto K. Liposome-encapsulated methemoglobin as an antidote against cyanide poisoning. J Control Release 2021; 337:59-70. [PMID: 34273418 DOI: 10.1016/j.jconrel.2021.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/06/2021] [Accepted: 07/12/2021] [Indexed: 12/12/2022]
Abstract
Cyanide induces acute lethal poisoning resulting from inhibition of cytochrome c oxidase located in the complex IV (Complex IV) of mitochondria. However, current therapies for cyanide poisoning using hydroxocobalamin and nitrous acid compounds remain a clinical issue. Here, we show that liposome-encapsulated methemoglobin (metHb@Lipo), nanosized biomimetic red blood cells, replicate the antidotal mechanism of nitrous acid compounds against cyanide poisoning, achieving superior efficacy and fast action with no adverse effects. The structure of metHb@Lipo, which consists of concentrated methemoglobin in its aqueous core and a lipid membrane resembling the red blood cell membrane, provides favorable characteristics as a cyanide antidote, such as binding properties and membrane permeability. Upon cyanide exposure, metHb@Lipo maintained the mitochondrial function in PC12 cells, resulting in a cell viability comparable to treatment with nitrous acid compounds. In a mouse model of cyanide poisoning, metHb@Lipo treatment dramatically improved mortality with a rapid recovery from the symptoms of cyanide poisoning compared to treatment with nitrous acid compounds. Furthermore, metHb@Lipo also possesses satisfactory pharmacokinetic properties without long-term bioaccumulation and toxicity. Our findings showed a novel concept to develop drugs for cyanide poisoning and provide a promising possibility for biomimetic red blood cell preparations for pharmaceutical applications.
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Affiliation(s)
- Yuto Suzuki
- Faculty of Pharmacy, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512, Japan
| | - Kazuaki Taguchi
- Faculty of Pharmacy, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512, Japan.
| | - Tomoko Kure
- Department of Chemistry, Nara Medical University, Shijo-cho 840, Kashihara, Nara 634-8521, Japan
| | - Hiromi Sakai
- Department of Chemistry, Nara Medical University, Shijo-cho 840, Kashihara, Nara 634-8521, Japan
| | - Yuki Enoki
- Faculty of Pharmacy, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512, Japan
| | - Masaki Otagiri
- Faculty of Pharmaceutical Sciences, Sojo University, 4-22-1 Ikeda, Nishi-ku, Kumamoto City, Kumamoto 860-0082, Japan; DDS Research Institute, Sojo University, 4-22-1 Ikeda, Nishi-ku, Kumamoto City, Kumamoto 860-0082, Japan
| | - Kazuaki Matsumoto
- Faculty of Pharmacy, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512, Japan
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Kumar A, Kumar R, Kumar S. Cyanide‐Ion‐Induced J‐Aggregation of Merocyanine Dye for Paper‐Based Colorimetric Detection in Water. ChemistrySelect 2021. [DOI: 10.1002/slct.202100147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Arvind Kumar
- Department of Chemistry, St. Stephen's College (University of Delhi) University Enclave Delhi 110007 India
| | - Rajesh Kumar
- Defence Laboratory Jodhpur Jodhpur 342011 Rajasthan India
| | - Satish Kumar
- Department of Chemistry, St. Stephen's College (University of Delhi) University Enclave Delhi 110007 India
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Khan H, Amin S, Tewari D, Nabavi SM, Atanasov AG. Plant-derived Glycosides with α-Glucosidase Inhibitory Activity: Current Standing and Future Prospects. Endocr Metab Immune Disord Drug Targets 2019; 19:391-401. [DOI: 10.2174/1871530319666181128104831] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 03/30/2018] [Accepted: 06/27/2018] [Indexed: 11/22/2022]
Abstract
Background:The α-glucosidase (EC 3.2.1.20), a calcium-containing intestinal enzyme which is positioned in the cells which cover the intestinal microvilli brush border. The carbohydrates require metabolism by α-glucosidase before being absorbed into the small intestine, and as a result, this enzyme represents a significant drug target for the effective management of diabetes. There are few α- glucosidase inhibitors in the clinical practice that is challenged by several limitations. Thus, new effective and safe therapeutic agents in this class are required. In this regard, plant secondary metabolites are a very promising source to be investigated. Herein in this review, we have focused on the preclinical studies on various glycosides with in vitro α-glucosidase inhibitory activity.Methods:The literature available on various websites such as GoogleScholar, PubMed, Scopus. All the peer-reviewed articles were included without considering the impact factor.Results:The surveyed literature revealed marked inhibitory profile of various glycosides derived from plants, and some of them were extremely potent relatively to the standard, acarbose in preclinical trials and exhibited multiple targeted effects.Conclusion:Keeping in view the results, these glycosides are strong candidates for further, more detailed studies to ascertain their clinical potential and for effective contribution in effective management of diabetes, where multiple targets are required to address
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Affiliation(s)
- Haroon Khan
- Department of Pharmacy, Abdul Wali Khan University Mardan, Mardan 23200, KPK, Pakistan
| | - Surrya Amin
- Department of Botany, Islamia College University Peshawar, Peshawar, Pakistan
| | - Devesh Tewari
- Department of Pharmaceutical Sciences, Faculty of Technology, Kumaun University Bhimtal Campus Nainital, Uttarakhand, India
| | - Seyed Mohammad Nabavi
- Applied Biotechnology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Atanas G. Atanasov
- Institute of Genetics and Animal Breeding of the Polish Academy of Sciences, 05-552 Jastrzebiec, Poland
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Chan YC, Fung HT, Lee CK, Tsui SH, Ngan HK, Sy MY, Tse ML, Kam CW, Wong GCK, Tong HK, Lit ACH, Wong TW, Lau FL. A Prospective Epidemiological Study of Acute Poisoning in Hong Kong. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790501200305] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To update our epidemiological knowledge of acute poisoning in Hong Kong. Methods A multi-centred prospective study was conducted for six months in six major accident and emergency departments in Hong Kong. A specially designed form was used to collect demographic data, type of poison involved, cause of poisoning, management, disposal as well as final outcome of the poisoned patients. Results A total of 1,467 patients (male: 588, female: 879) were included in the study. Most of them were young adults (32% were between 20 and 40 years old). Suicidal attempt (64%) was the most common cause of poisoning. Notably, 379 (26%) patients took more than one poison. Among the 2,007 counts of poison taken, sleeping pills (24%) and analgesics (18%) were the most commonly used drugs and paracetamol was the commonest single ingredient involved in poisoning. Most patients were treated with supportive measures, and about 40% and 15% of the patients were given gastrointestinal decontamination and specific antidotes respectively in their management, in which activated charcoal and N-acetylcysteine were the most common. Concerning disposal from the emergency department, 91% of the poisoned cases required in-patient management. Most patients had an uneventful recovery but 5 (0.3%) had significant disability and 21 (1.4%) died. Suicidal carbon monoxide poisoning was the leading cause of mortality in our study. Conclusions Most acute poisonings in Hong Kong were suicidal in nature and paracetamol was the commonest agent. Activated charcoal was the most commonly used decontamination method and most patients had an uneventful recovery.
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Affiliation(s)
| | - HT Fung
- Tuen Mun Hospital, Accident & Emergency Department, Tsing Chung Koon Road, Tuen Mun, N.T., Hong Kong
| | - CK Lee
- Queen Elizabeth Hospital, Accident & Emergency Department, 30 Gascoigne Road, Kowloon, Hong Kong
| | - SH Tsui
- Queen Mary Hospital, Accident & Emergency Department, Pokfulam Road, Hong Kong
| | - HK Ngan
- Yan Chai Hospital, Accident & Emergency Department, Tsuen Wan, N.T., Hong Kong
| | - MY Sy
- Pamela Youde Nethersole Eastern Hospital, Accident & Emergency Department, 3 Lok Man Road, Chaiwan, Hong Kong
| | | | - CW Kam
- Tuen Mun Hospital, Accident & Emergency Department, Tsing Chung Koon Road, Tuen Mun, N.T., Hong Kong
| | - GCK Wong
- North District Hospital, Accident & Emergency Department, 9 Po Kin Road, Sheung Shui, N.T., Hong Kong
| | - HK Tong
- Queen Mary Hospital, Accident & Emergency Department, Pokfulam Road, Hong Kong
| | - ACH Lit
- Yan Chai Hospital, Accident & Emergency Department, Tsuen Wan, N.T., Hong Kong
| | - TW Wong
- Pamela Youde Nethersole Eastern Hospital, Accident & Emergency Department, 3 Lok Man Road, Chaiwan, Hong Kong
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Lavon O, Avrahami A, Eisenkraft A. Effectiveness of isosorbide dinitrate in cyanide poisoning as a function of the administration timing. BMC Pharmacol Toxicol 2017; 18:13. [PMID: 28288687 PMCID: PMC5348846 DOI: 10.1186/s40360-017-0122-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 02/04/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Better and safer antidotes against cyanide poisoning are needed. Prior study has shown a favorable effect of isosorbide dinitrate (ISDN) on the survival of cyanide-poisoned rabbits when administered as early as 1 min after poisoning. The aim of the current study was to further evaluate the efficacy of intravenous ISDN administered in clinically relevant timing for first responders. METHODS A comparative animal study using 24 rabbits in 4 randomized study groups was performed. Animals were poisoned with intravenous potassium cyanide (1 mg/kg). Animals in Group 1 served as controls and received no treatment. Groups 2-4 animals were treated intravenously with ISDN (50 μg/kg) after poisoning; one group after 3 min, another group after 5 min and the last after 7 min. Animals were observed for 30 min after poisoning. The study endpoints included survival rate, clinical status, blood pressure, pulse per minute, blood lactate and pH. RESULTS Five of 6 animals (83.3%) from every treatment group survived the whole observation period while all control untreated animals died. All the rabbits collapsed immediately after exposure, showing rapidly deteriorated vital signs with lactic metabolic acidosis (peak blood lactate levels of 18.1 to 19.0 mmol/L on average at 10 min post exposure). Vital signs, clinical scores, and blood gases of treated rabbits gradually improved. CONCLUSION Poisoned rabbits showed improved short-term survival following the administration of ISDN up to 7 min after lethal cyanide poisoning of. We see a potential for ISDN as an antidote against cyanide poisoning.
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Affiliation(s)
- Ophir Lavon
- Clinical Pharmacology and Toxicology Unit, Carmel Medical Center, 7 Michal St., Haifa, 3436212 Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Amit Avrahami
- Pre Clinical Research Authority, Technion-Israel Institute of Technology, Haifa, Israel
| | - Arik Eisenkraft
- Institute for Research in Military Medicine, Faculty of Medicine, Hebrew University, Jerusalem, Israel
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Mahernia S, Amanlou A, kiaee G, Amanlou M. Determination of hydrogen cyanide concentration in mainstream smoke of tobacco products by polarography. JOURNAL OF ENVIRONMENTAL HEALTH SCIENCE & ENGINEERING 2015. [PMID: 26225214 PMCID: PMC4518591 DOI: 10.1186/s40201-015-0211-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND There has been a worldwide concern for the health risks of cigarette smoking and hydrogen cyanide (HCN) considered as one of the hazardous tobacco compounds which is needed to be determined in order to reduce the dose related to smoke disease risk. In this study, we prepare the experimental procedure to entrap the HCN from mainstream smoke of different brands of Tehran cigarette, through simulating human inhalation and determine its concentration applying polarography. RESULTS The HCN level of the 50 commonly consumed tobacco products (47 cigarettes and 3 cigars) obtained from local store is ranged between 17.56 ± 1.02 and 1553.98 ± 0.56 μg per stick, this acquired amount is more than FDA approval (10 μg per stick), so the harmful effects of smoking is indicative. CONCLUSIONS The comparative study of the results shows that the price and the weight of each product do not indicate HCN level. As can be seen, R(2) value which is a statistical measure of how close the data are to the fitted regression line is low (R(2) < 0.2). So it should not be deceived by names such as ultra light or infinite gravity to suck, because this names or the price haven(')t effect on the amount of HCN and its destructive effects.
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Affiliation(s)
- Shabnam Mahernia
- Department of Medicinal Chemistry, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Amanlou
- Department of Medicinal Chemistry, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Gita kiaee
- Department of Medicinal Chemistry, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Massoud Amanlou
- Department of Medicinal Chemistry, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Khairnar N, Tayade K, Bothra S, Sahoo SK, Singh J, Singh N, Bendre R, Kuwar A. Novel fluorescent chemosensing of CN− anions with nanomolar detection using the Zn2+–isonicotinohydrazide metal complex. RSC Adv 2014. [DOI: 10.1039/c4ra06358a] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A novel chemosensor based on the Zn2+–isonicotinohydrazide complex ‘(ZnL)’ was developed for the selective detection of cyanide (CN−) over other tested anions, such as HSO4−, F−, Cl−, Br−, I−, NO3−, PO43−, SO42−, SCN−, S2−, CH3COO− and H2PO4− in 100% aqueous medium.
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Affiliation(s)
- Nilesh Khairnar
- School of Chemical Sciences
- North Maharashtra University
- Jalgaon, India
| | - Kundan Tayade
- School of Chemical Sciences
- North Maharashtra University
- Jalgaon, India
| | - Shilpa Bothra
- Department of Applied Chemistry
- SV National Institute Technology
- Surat-395007, India
| | - Suban K. Sahoo
- Department of Applied Chemistry
- SV National Institute Technology
- Surat-395007, India
| | - Jasminder Singh
- Department of Chemistry
- Indian Institute Technology
- Ropar-140 001, India
| | - Narinder Singh
- Department of Chemistry
- Indian Institute Technology
- Ropar-140 001, India
| | - Ratnamala Bendre
- School of Chemical Sciences
- North Maharashtra University
- Jalgaon, India
| | - Anil Kuwar
- School of Chemical Sciences
- North Maharashtra University
- Jalgaon, India
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10
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Gaskin S, Pisaniello D, Edwards JW, Bromwich D, Reed S, Logan M, Baxter C. Chlorine and hydrogen cyanide gas interactions with human skin: in vitro studies to inform skin permeation and decontamination in HAZMAT incidents. JOURNAL OF HAZARDOUS MATERIALS 2013; 262:759-765. [PMID: 24140525 DOI: 10.1016/j.jhazmat.2013.09.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 09/14/2013] [Accepted: 09/16/2013] [Indexed: 06/02/2023]
Abstract
Accidental or intentional toxic gas releases may result in significant public health and psychological consequences. Management of exposed individuals during HAZMAT incidents should be risk-based and supported by a suitable scientific evidence base. There appear to be large evidence gaps in relation to dermal absorption of gases, as well as management advice for potentially exposed individuals. Chlorine and hydrogen cyanide are two common HAZMAT gases and this paper addresses the need for experimental data tailored to HAZMAT scenarios and first responders. In addition to time variations of gas concentration, the modifying effects of clothing, temperature, and oil-based sunscreen on epidermal absorption and penetration are assessed. Results for chlorine show little penetration up to 500 ppm but with small enhancing effects due to heavy cotton and oil-based sunscreen. Hydrogen cyanide up to 800 ppm shows minor penetration consistent with previous studies, with little variability in the presence of sunscreen and clothing. Practical guidelines to support the decision-making of emergency responders with regard to personal decontamination have been derived.
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Affiliation(s)
- Sharyn Gaskin
- Discipline of Public Health, School of Population Health, University of Adelaide, South Australia 5005, Australia; Health and Environment, School of the Environment, Flinders University, South Australia 5042, Australia
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Comparison of techniques for securing the endotracheal tube while wearing chemical, biological, radiological, or nuclear protection: a manikin study. Prehosp Disaster Med 2011; 25:589-94. [PMID: 21181696 DOI: 10.1017/s1049023x00008803] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The objective of this study was to assess the impact of chemical, biological, radiological, nuclear personal protective equipment (CBRN-PPE) on the ability to secure an endotracheal tube (ETT) with either the Thomas Tube Holder™ or cotton tape tied in a knot. METHODS Seventy-five clinicians secured an ETT in a previously intubated manikin with the Thomas Tube Holder™ and cotton tape. A mixed quantitative and qualitative research design was used to gauge actual performance times and perceptions of difficulties. Following completion of the study, 25 clinicians were interviewed to gauge their experiences of securing the ETT with both devices while wearing CBRN-PPE. RESULTS The mean time to apply the Thomas Tube Holder was 29.02 seconds, compared with tape which took a mean of 58 seconds (p=0.001). Clinicians rated the Thomas Tube Holder as easier to use than tape (Mann-Whitney z=9.934; p<0.001), which was confirmed during interviews. Of the clinicians interviewed, 92% perceived that the Thomas Tube Holder provided the better method for securing an ETT, none of the clinicians identified the tape as the best method for securing the endotracheal tube while wearing CBRN-PPE. Clinicians identified that the design of the Thomas Tube Holder facilitated the gross motor movement required for application. CONCLUSIONS The Thomas Tube Holder is easier and faster to apply when wearing CBRN-PPE when compared with cotton, and the Thomas Tube Holder is perceived by the participants as being more effective at preventing accidential extubation.
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Holstege CP, Forrester JD, Borek HA, Lawrence DT. A case of cyanide poisoning and the use of arterial blood gas analysis to direct therapy. Hosp Pract (1995) 2010; 38:69-74. [PMID: 21068529 DOI: 10.3810/hp.2010.11.342] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Cyanide poisoning is a difficult diagnosis for health care professionals. Existing reports clearly demonstrate that the initial diagnosis is often missed in surreptitious cases. The signs and symptoms can mimic numerous other disease processes. We report a case in which a suicidal patient ingested cyanide and was found unresponsive by 2 laboratory coworkers. The coworkers employed cardiopulmonary resuscitation with mouth-to-mouth resuscitation. The suicidal patient died shortly after arrival to the hospital, while the 2 coworkers who performed mouth-to-mouth resuscitation presented with signs and symptoms that mimicked early cyanide toxicity but were instead due to acute stress response. An arterial blood gas analysis may help aid in the diagnosis of cyanide toxicity. Electrocardiographic findings in a patient with cyanide poisoning range significantly, depending on the stage of the poisoning.
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Affiliation(s)
- Christopher P Holstege
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA.
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Lavon O, Bentur Y. Does amyl nitrite have a role in the management of pre-hospital mass casualty cyanide poisoning? Clin Toxicol (Phila) 2010; 48:477-84. [PMID: 20653465 DOI: 10.3109/15563650.2010.505573] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Amyl nitrite has been recommended as a cyanide antidote for several decades. Its antidotal properties were initially attributed to induction of methemoglobin and later to a nitric oxide mediated hemodynamic effect. The ease of administration and alleged rapid clinical effect would recommend its wide use in the pre-hospital management of mass casualty cyanide poisoning; yet there are concerns regarding the use of amyl nitrite for this indication. OBJECTIVE Review the data on amyl nitrite in cyanide poisoning and evaluate its efficacy and safety in mass casualty cyanide poisoning. METHODS A literature search utilizing PubMed, Toxnet, textbooks in toxicology and pharmacology, and the bibliographies of the articles retrieved identified 17 experimental studies and human reports on the use of amyl nitrite in cyanide poisoning, and 40 additional articles on amyl nitrite's properties and adverse effects. One paper was excluded as it was a conference abstract with limited data. MECHANISMS OF ACTION The antidotal properties of amyl nitrite were attributed initially to induction of methemoglobinemia and later to nitric oxide mediated vasodilation. EFFICACY EXPERIMENTAL STUDIES Animal studies on the use of amyl nitrite in cyanide poisoning are limited, and their results are inconsistent, which makes their extrapolation to humans questionable. EFFICACY HUMAN STUDIES Clinical reports are limited in number and the part played by amyl nitrite relative to the other treatments administered (e.g. life support, sodium nitrite, and sodium thiosulfate) is unclear. ADVERSE EFFECTS Amyl nitrite can be associated with potentially serious adverse reactions such as hypotension, syncope, excessive methemoglobinemia, and hemolysis in G6PD deficient patients. These effects are more pronounced in young children, in the elderly, and in patients with cardiac and pulmonary disorders. Dose regimen. The method of administration of amyl nitrite (breaking pearls into gauze or a handkerchief and applying it intermittently to the victim's nose and mouth for a few minutes) is not easily controlled, might result in under- or over-dosing, can prevent the caregiver from administering life support, and possibly expose him/her to amyl nitrite's adverse effects. CONCLUSIONS Administration of amyl nitrite in mass casualty cyanide poisoning can result in unnecessary morbidity and may interfere with the proper management of the incident and the required supportive treatment and rapid evacuation. In the authors' opinion these drawbacks make the use of amyl nitrite in pre-hospital mass casualty cyanide poisoning unwarranted.
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Affiliation(s)
- Ophir Lavon
- Rambam Health Care Campus, Israel Poison Information Center, Haifa, Israel
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Abstract
Cyanide has several antidotes, with differing mechanisms of action and diverse toxicological, clinical, and risk-benefit profiles. The international medical community lacks consensus about the antidote or antidotes with the best risk-benefit ratio. Critical assessment of cyanide antidotes is needed to aid in therapeutic and administrative decisions that will improve care for victims of cyanide poisoning (particularly poisoning from enclosed-space fire-smoke inhalation), and enhance readiness for cyanide toxic terrorism and other mass-casualty incidents. This paper reviews preclinical and clinical data on available cyanide antidotes and considers the profiles of these antidotes relative to properties of a hypothetical ideal cyanide antidote. Each of the antidotes shows evidence of efficacy in animal studies and clinical experience. The data available to date do not suggest obvious differences in efficacy among antidotes, with the exception of a slower onset of action of sodium thiosulfate (administered alone) than of the other antidotes. The potential for serious toxicity limits or prevents the use of the Cyanide Antidote Kit, dicobalt edetate, and 4-dimethylaminophenol in prehospital empiric treatment of suspected cyanide poisoning. Hydroxocobalamin differs from these antidotes in that it has not been associated with clinically significant toxicity in antidotal doses. Hydroxocobalamin is an antidote that seems to have many of the characteristics of the ideal cyanide antidote: rapid onset of action, neutralizes cyanide without interfering with cellular oxygen use, tolerability and safety profiles conducive to prehospital use, safe for use with smoke-inhalation victims, not harmful when administered to non-poisoned patients, easy to administer.
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Affiliation(s)
- Alan H Hall
- Toxicology Consulting and Medical Translating Services, Inc., Laramie, WY 82072, USA.
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Hall AH, Dart R, Bogdan G. Sodium Thiosulfate or Hydroxocobalamin for the Empiric Treatment of Cyanide Poisoning? Ann Emerg Med 2007; 49:806-13. [PMID: 17098327 DOI: 10.1016/j.annemergmed.2006.09.021] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2006] [Revised: 08/31/2006] [Accepted: 09/25/2006] [Indexed: 11/21/2022]
Abstract
Cyanide poisoning must be seriously considered in victims of smoke inhalation from enclosed space fires; it is also a credible terrorism threat agent. The treatment of cyanide poisoning is empiric because laboratory confirmation can take hours or days. Empiric treatment requires a safe and effective antidote that can be rapidly administered by either out-of-hospital or emergency department personnel. Among several cyanide antidotes available, sodium thiosulfate and hydroxocobalamin have been proposed for use in these circumstances. The evidence available to assess either sodium thiosulfate or hydroxocobalamin is incomplete. According to recent safety and efficacy studies in animals and human safety and uncontrolled efficacy studies, hydroxocobalamin seems to be an appropriate antidote for empiric treatment of smoke inhalation and other suspected cyanide poisoning victims in the out-of-hospital setting. Sodium thiosulfate can also be administered in the out-of-hospital setting. The efficacy of sodium thiosulfate is based on individual case studies, and there are contradictory conclusions about efficacy in animal models. The onset of antidotal action of sodium thiosulfate may be too slow for it to be the only cyanide antidote for emergency use. Hydroxocobalamin is being developed for potential introduction in the United States and may represent a new option for emergency personnel in cases of suspected or confirmed cyanide poisoning in the out-of-hospital setting.
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Affiliation(s)
- Alan H Hall
- Toxicology Consulting and Medical Translating Services, Inc., Elk Mountain, WY 82324, USA.
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Planning and Preparedness for Mass-Gathering Events—EURO 2004. Prehosp Disaster Med 2005. [DOI: 10.1017/s1049023x00014321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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The Humaneness of Rodent Pest Control. Anim Welf 2003. [DOI: 10.1017/s0962728600025355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AbstractRat and mouse control methods potentially affect the welfare of many millions of animals every year. Here, the humaneness of the methods used in the UK and the USA is assessed in terms of their speed and mode of action, the appearance and behaviour of affected animals, experiences of human victims, long-term effects on animals that survive exposure, and welfare risks to non-target animals. Several methods emerge as relatively humane: cyanide, alpha-chloralose, electrocution traps and well-designed snap traps all usually kill swiftly and with little distress. Preventative methods such as rodent-proofing are also humane, as well as an essential — and probably under-used — component of effective control. However, anticoagulant poisons, the most common means of controlling rodents, generally take several days to kill, during which time they cause distress, disability and/or pain. Sub-lethally affected animals are also likely to experience haemorrhages and their sequelae, and carnivores feeding on affected rodents may be secondarily poisoned. The acute rodenticides zinc phosphide and calciferol are also generally inhumane, the former typically causing severe pain for several hours, and the latter, pain and illness for several days. Sticky boards, to which rodents become adhered by the feet and fur until they are killed or simply eventually die, also raise very serious welfare concerns. This evidence highlights remarkable paradoxes in the way society treats different classes of animal, and argues for more education, legislation and research targeted at reducing the vast numbers of rodents currently killed inhumanely.
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Mannaioni G, Vannacci A, Marzocca C, Zorn AM, Peruzzi S, Moroni F. Acute cyanide intoxication treated with a combination of hydroxycobalamin, sodium nitrite, and sodium thiosulfate. JOURNAL OF TOXICOLOGY. CLINICAL TOXICOLOGY 2002; 40:181-3. [PMID: 12126191 DOI: 10.1081/clt-120004408] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
An 80-year-old diabetic patient was admitted to the hospital because of sudden unconsciousness and severe metabolic acidosis. His son reported the possibility of cyanide poisoning. Clinical data and the detection of cyanide in blood and gastric material confirmed this possibility. Supportive therapy and the following antidotes--sodium nitrite two doses 300 mg i.v., sodium thiosulfate 3 g i.v., and hydroxocobalamin 4 g in 24 hours--were administered immediately and the patient completely recovered in 48 hours. Our observations suggest that timely and appropriate use of antidotes for cyanide intoxication may prevent death, even in aged diabetic patients.
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Affiliation(s)
- Guido Mannaioni
- Department of Preclinical and Clinical Pharmacology, University of Florence, Italy
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Abstract
This article covers the major chemicals and gases that are considered to be of the most clinical relevance to the primary care provider. The reader is referred to other comprehensive textbooks of toxicology and occupational medicine for a complete discussion of the numerous additional products found in the workplace that may result in occupational exposure.
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Affiliation(s)
- R J Harrison
- Division of Occupational and Environmental Medicine, University of California School of Medicine, San Francisco, California, USA.
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