CHAPTER 86 CYANIDE POISONING AND HYDROXOCOBALAMIN

Prospective Study of Hydroxocobalamin for Acute Cyanide Poisoning in Smoke Inhalation

Borron SW, Baud FJ, Barriot P, Imbert M, Bismuth C. Ann Emerg Med. 2007;49(6):794–801

BACKGROUND

Cyanide poisoning has long been recognized as a significant health hazard from fire smoke inhalation, with untreated mortality exceeding 50%. The cyanide that is produced from the combustion of nitrogen- and carbon-containing substances (i.e., foam, plastics, nylon, wool) causes a cellular hypoxia that leads to altered mental status, cardiovascular instability, and a significant metabolic acidosis. While a cyanide antidote kit consisting of amyl nitrite, sodium nitrite, and sodium thiosulfate was found to reduce the morbidity and mortality of cyanide toxicity, it often went unused because of the risk of methemoglobinemia from concurrent smoke inhalation. Hydroxocobalamin, a vitamin B12 precursor, has been licensed for use in France since 1996. It received FDA approval in 2006 for the treatment of acute cyanide toxicity despite a paucity of prospective evaluation.

OBJECTIVES

To determine if empiric, prehospital administration of hydroxocobalamin could safely and effectively treat patients with acute cyanide toxicity following smoke inhalation.

METHODS

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