Review article: Management of cyanide poisoning

Reade, Michael C., Davies, Suzanne R., Morley, Peter T., Dennett, Jennifer, Jacobs, Ian C. and on behalf of Australian Resuscitation Council (2012) Review article: Management of cyanide poisoning. Emergency Medicine Australasia, 24 3: 225-238. doi:10.1111/j.1742-6723.2012.01538.x


Author Reade, Michael C.
Davies, Suzanne R.
Morley, Peter T.
Dennett, Jennifer
Jacobs, Ian C.
on behalf of Australian Resuscitation Council
Total Author Count Override 5
Title Review article: Management of cyanide poisoning
Journal name Emergency Medicine Australasia   Check publisher's open access policy
ISSN 1742-6731
1742-6723
Publication date 2012
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1111/j.1742-6723.2012.01538.x
Volume 24
Issue 3
Start page 225
End page 238
Total pages 14
Place of publication Richmond, Vic., Australia
Publisher Wiley-Blackwell Publishing
Collection year 2013
Language eng
Abstract Cyanide poisoning is uncommon, but generates interest because of the presumed utility of an antidote immediately available in those areas with a high risk of cyanide exposure. As part of its regular review of guidelines, the Australian Resuscitation Council conducted a systematic review of the human evidence for the use of various proposed cyanide antidotes, and a narrative review of the relevant pharmacological and animal studies. There have been no relevant comparative or placebo-controlled human trials. Nine case series were identified. Treatment with hydroxocobalamin was reported in a total of 361 cases. No serious adverse effects of hydroxocobalamin were reported, and many patients with otherwise presumably fatal poisoning survived. Sodium thiosulphate use was reported in two case series, similarly with no adverse effects. Treatment with a combination of sodium nitrite, amyl nitrite and sodium thiosulphate was reported in 74 patients, with results indistinguishable from those of hydroxocobalamin and sodium thiosulphate. No case series using dicobalt edetate or 4-dimethylaminophenol were identified, but successful use in single cases has been reported. Hydroxocobalamin and sodium thiosulphate differ from alternatives in having negligible adverse effects, and on the basis of current evidence are the antidotes of choice. The indications for the use of an antidote, the requirements for supportive care and a recommended approach for workplaces where there is a risk of cyanide poisoning are presented.
Keyword Antidote
Cyanide
Poisoning
Resuscitation
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Article first published online: 21 FEB 2012

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2013 Collection
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Created: Wed, 07 Mar 2012, 16:31:22 EST by Michael Reade on behalf of School of Medicine