Sodium nitroprusside is a short-acting, parenterally administered vasodilator that is used to treat severe hypertension and cardiac failure. It also is used to treat hypertension in postoperative cardiac surgery patients and to induce hypotension for certain surgical procedures. Toxicity may occur with acute high-dose nitroprusside treatment or with prolonged infusions.

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   Mechanism of toxicity. Nitroprusside is rapidly hydrolyzed (half-life, 11 minutes) and releases free cyanide, which normally is converted quickly to thiocyanate by rhodanase enzymes in the liver and blood vessels. Cardiopulmonary bypass–associated free hemoglobin release accelerates the release of free cyanide and may increase the risk for cyanide toxicity.

   
   
   
   
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      Acute cyanide poisoning (See Cyanide) may occur with short-term high-dose nitroprusside infusions (eg, >10–15 mcg/kg/min for ≥ 1 hour).

      
      
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      Thiocyanate is eliminated by the kidneys and may accumulate in patients with renal insufficiency, especially after prolonged infusions.

   
   
   
   
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   Toxic dose. The toxic dose depends on renal function and the rate of infusion.

   
   
   
   
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      Clinical cyanide

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