![]() This reaction allows the thiosulfate ions to react with cyanide ions to form sulfite and thiocyanate. Endogenous detoxification of cyanide occurs via the rhodanese reaction. Hydroxocobalamin binds to cyanide, forming cyanocobalamine (vitamin B-12), which is no longer toxic and is excreted by the kidneys. The one that is utilized the most is Hydroxycobalamin which is given intravenously to the poisoning victim. There are several commercial antidotes available for cyanide poisoning. ![]() It is theorized that HBO2 causes changes in the whole blood cyanide level by hyperoxygenation competing with the cyanide and forcing it out of the cells. HBO2 has been recommended for cyanide poisoning as well. Hyperbaric oxygen (HBO2) is a mainstay of treatment for carbon monoxide poisoning. Unlike carbon monoxide, which can be quantified by measuring carboxyhemoglobin level, there is no way to quantify cyanide poisoning. This activity describes the pathophysiology of cyanide poisoning and highlights the role of the interprofessional team in the management of these patients. Hydrogen cyanide has also been used in chemical warfare (gas chambers in German concentration camps in World War II) because inhalation leads quickly to death. Other sources include workplace exposure, prolonged administration of sodium nitroprusside, insecticides, metalworking, bitter almonds, and the seeds of some fruits such as apricots. Patients presenting from structure fires with carbon monoxide poisoning should be assumed to have been exposed to toxic levels of cyanide as well since most modern buildings contain these materials. Cyanide forms as a result of incomplete combustion of materials containing nitrogen (plastics, vinyl, acrylics, nylon, neoprene, rubber, insulation). ![]() ![]() Cyanide toxicity occurs commonly in patients with smoke inhalation who have been removed from burning structures.
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