Antidotal efficacy of alpha-ketoglutaric acid and sodium thiosulfate in cyanide poisoning

Beneficial effect of sodium thiosulfate extends beyond myocardial tissue in isoproterenol model of infarction: Implication for nootropic effects

One of the common negative impacts in the management of acute myocardial infarction is cognitive decline. Using the rat model of isoproterenol (ISO)-induced myocardial infarction, we assessed the cardioprotective effect of sodium thiosulfate (STS) and its influence on cognition. STS treatment reduced the cardiac infarct size by 75%, injury markers (lactate dehydrogenase: 60%, creatine kinase-muscle/brain: 44%) release in the blood, maintain the heart rate within a normal range (365 ± 10 bpm) and minimize postinfarction hypertrophic changes in comparison with the ISO group. At the cellular level, the heart from these rats had reduced reactive oxygen species (ROS) (25%), caspase-9 (60%), and improved mitochondrial function (restored electron transport chain function and copy number) compared to ISO hearts. The brain of STS-treated rats also showed a reduction in ROS (45%), caspase-9 (37%), and improved mitochondrial function relative to the brain of the ISO group, particularly limited to the striatum region, and these rats showed improved cognitive ability. Predominantly, the STS treatment reduced the reference memory defects observed in comparison to rats challenged by ISO. Furthermore, elevated circulating mitochondrial DNA and ATP were found in ISO-challenged rats, which indicate the cardiac mitochondria linked damage-associated patterns were restored to the sham level when pretreated with STS. We found increased H₂ S, a well-known metabolite of STS with a neuroprotective role in the brain after STS administration, hinting at a possible secondary defense mechanism. In conclusion, the STS mediated cardioprotection and its nootropic effects are primarily mediated via the improvement of mitochondrial function and reduction of oxidative stress.

Antidotes and treatments for chemical warfare/terrorism agents: an evidence-based review

This article reviews the evidence supporting the efficacy of antidotes used or recommended for the potential chemical warfare agents of most concern. Chemical warfare agents considered include cyanide, vesicants, pulmonary irritants such as chlorine and phosgene, and nerve agents. The strength of evidence for most antidotes is weak, highlighting the need for additional research in this area.

Cyanide poisoning and its treatment

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.