EFFECTIVENESS OF INTRAMUSCULARLY ADMINISTERED CYANIDE ANTIDOTES ON METHEMOGLOBIN FORMATION AND SURVIVAL

Citation
Ja. Vick et Jd. Vonbredow, EFFECTIVENESS OF INTRAMUSCULARLY ADMINISTERED CYANIDE ANTIDOTES ON METHEMOGLOBIN FORMATION AND SURVIVAL, Journal of applied toxicology, 16(6), 1996, pp. 509-516
Citations number
30
Categorie Soggetti
Toxicology
ISSN journal
0260437X
Volume
16
Issue
6
Year of publication
1996
Pages
509 - 516
Database
ISI
SICI code
0260-437X(1996)16:6<509:EOIACA>2.0.ZU;2-K
Abstract
Successful first aid therapy for cyanide intoxication is dependent upo n immediate administration of antidotes which directly or indirectly i nteract with the cyanide ion to remove it from circulation. Owing to t he severe respiratory, cardiovascular and convulsive episodes followin g acute cyanide intoxication, the most practical approach is to admini ster antidotes by intramuscular injection, Exceptionally rapid methemo globin formers-hydroxylamine hydrochloride (HH) and dimethylaminopheno l (DMAP)-are usually able to prevent the lethal effect of cyanide foll owing intramuscular injections in doses sufficient to induce 20% methe moglobin (HH = 20 mg kg(-1) and DMAP = 2 mg kg(-1)). Sodium nitrite, t he methemoglobin inducer approved for military use, must be administer ed by intravenous infusion because it is not an effective cyanide anti dote by the intramuscular route, In the normal unintoxicated animal an intramuscular injection of 20 mg kg(-1) sodium nitrite will form 20% methemoglobin; however, in acute cyanide intoxication the associated s evere bradycardia appears to limit the rate of absorption and thus the rapid formation of methemoglobin, If the bradycardia is prevented or reversed by atropine, the rate of absorption of sodium nitrite and the formation of methemoglobin is able to reverse the otherwise lethal ef fects of cyanide, Thus, an intramuscularly administered combination of 20 mg kg(-1) sodium nitrite and 1 mg kg(-1) atropine sulfate, rapidly absorbed from the intramuscular site, appears to achieve the same deg ree of effectiveness against acute cyanide intoxication as intramuscul arly administered HH or DMAP, It would appear from these studies that HH, DMAP and sodium nitrite with atropine are all potentially effectiv e intramuscular antidotes for acute cyanide poisoning.