Acute Cyanide Intoxication Treated with a Combination of Hydroxycobalamin, Sodium Nitrite, and Sodium Thiosulfate

Guido Mannaioni Medical Toxicology Unit, Department of Preclinical and Clinical Pharmacology, University of Florence, Florence, Italy

Alfredo Vannacci Medical Toxicology Unit, Department of Preclinical and Clinical Pharmacology, University of Florence, Florence, Italy

Cosimo Marzocca Medical Toxicology Unit, Department of Preclinical and Clinical Pharmacology, University of Florence, Florence, Italy

Anna Monica Zorn Medical Toxicology Unit, Department of Preclinical and Clinical Pharmacology, University of Florence, Florence, Italy

Sandro Peruzzi Medical Toxicology Unit, Department of Preclinical and Clinical Pharmacology, University of Florence, Florence, Italy

Flavio Moroni Medical Toxicology Unit, Department of Preclinical and Clinical Pharmacology, University of Florence, Florence, Italy

Abstract

An 80-year-old diabetic patient was admitted to the hospital because of sudden unconsciousness and severe metabolic acidosis. His son reported the possibility of cyanide poisoning. Clinical data and the detection of cyanide in blood and gastric material confirmed this possibility. Supportive therapy and the following antidotes—sodium nitrite two doses 300 mg IV, sodium thiosulfate 3 g IV, and hydroxocobalamin 4 g in 24 hours—were administered immediately and the patient completely recovered in 48 hours. Our observations suggest that timely and appropriate use of antidotes for cyanide intoxication may prevent death, even in aged diabetic patients.

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Acute Cyanide Intoxication Treated with a Combination of Hydroxycobalamin, Sodium Nitrite, and Sodium Thiosulfate

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Acute Cyanide Intoxication Treated with a Combination of Hydroxycobalamin, Sodium Nitrite, and Sodium Thiosulfate

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