Elsevier

Annals of Emergency Medicine

Volume 22, Issue 9, September 1993, Pages 1413-1418
Annals of Emergency Medicine

Original contribution
Cyanide and methemoglobin kinetics in smoke inhalation victims treated with the cyanide antidote kit

https://doi.org/10.1016/S0196-0644(05)81988-2Get rights and content

Study objective:

To evaluate serial cyanide, methemoglobin, and carbon monoxide levels in smoke inhalation patients.

Setting:

Regional poison center and regional toxicology treatment center.

Participants:

Seven critically ill smoke inhalation patients referred to the regional poison center.

Interventions:

Peak level and half-life were determined by obtaining serial carboxyhemoglobin, cyanide, and methemoglobin levels.

Results:

The mean observed half-life of cyanide was 3.0 ± 0.6 hours. Methemoglobinemia was evaluated in four patients after sodium nitrite administration. The peak measured methemoglobin levels (mean, 10.5% ± 2%; range, 7.9% to 13.4%) did not occur until a mean of 50 minutes (range, 35 to 70 minutes) following administration of sodium nitrite. The total oxygen-carrying capacity reduced by the combination of carboxyhemoglobin and methemoglobin was never more than 21% (range, 10% to 21%) in this series.

Conclusion:

The administration of sodium nitrite to smoke inhalation patients in the presence of concomitant carbon monoxide poisoning may be relatively safe.

References (20)

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    It is well known that CN poisoning is a type of chemical asphyxia caused by the disturbance of cellular respiration and the essential mechanism is the inhibition of CCO activity due to its binding to this enzyme [12–14]. It is also known that MetHb can detoxify CN by binding this poisonous substance immediately in blood (formation of cyanmethemoglobin) and the nitrites are widely used therapeutic agent for CN poisoning as MetHb formers [13,16,17]. Fire gases contain a considerable amount of nitrogen oxides and CN in blood was reported to be bound to produced MetHb in fire victims [8,10,11].

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Presented at the AAPCC/AACT/ABMT/CAPCC Annual Scientific Meeting in Atlanta, Georgia, October 1989.

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