Hydroxocobalamin for severe acute cyanide poisoning by ingestion or inhalation

Borron, Stephen W.; Baud, Frédéric J.; Mégarbane, Bruno; Bismuth, Chantal

doi:10.1016/j.ajem.2006.10.010

« Previous Next »American Journal of Emergency Medicine
Volume 25, Issue 5 , Pages 551-558, June 2007

Hydroxocobalamin for severe acute cyanide poisoning by ingestion or inhalation☆

Stephen W. Borron, MD, MS
- University of Texas Health Science Center, San Antonio, TX 78229, USA
Frédéric J. Baud, MD
- Assistance Publique-Hôpitaux de Paris, Medical and Toxicological Critical Care Department, Lariboisière Hospital, University de Paris 7, INSERM U705, Paris, France
- Assistance Publique-Hôpitaux de Paris, Medical and Toxicological Critical Care Department, Fernand Widal Hospital, University of Paris 7, Paris, France
- Corresponding author. Assistance Publique-Hôpitaux de Paris, Medical and Toxicological Critical Care Department, Lariboisière Hospital, University Paris 7, INSERM U705, Paris, France. Tel.: +33 1 49 95 64 91; fax: +33 1 49 95 65 78.
Bruno Mégarbane, MD, PhD
- Assistance Publique-Hôpitaux de Paris, Medical and Toxicological Critical Care Department, Lariboisière Hospital, University de Paris 7, INSERM U705, Paris, France
Chantal Bismuth, MD
- Assistance Publique-Hôpitaux de Paris, Medical and Toxicological Critical Care Department, Fernand Widal Hospital, University of Paris 7, Paris, France

Received 31 August 2006; accepted 26 October 2006.

Abstract

This chart review was undertaken to assess efficacy and safety of hydroxocobalamin for acute cyanide poisoning. Hospital records of the Fernand Widal and Lariboisière Hospitals were reviewed for intensive care unit admissions with cyanide poisoning for which hydroxocobalamin was used as first-line treatment from 1988 to 2003. Smoke inhalation cases were excluded. Hydroxocobalamin (5-20 g) was administered to 14 consecutive patients beginning a median 2.1 hours after cyanide ingestion or inhalation. Ten patients (71%) survived and were discharged. Of the 11 patients with blood cyanide exceeding the typically lethal threshold of 100 μmol/L, 7 survived. The most common hydroxocobalamin-attributed adverse events were chromaturia and pink skin discoloration. Severe cyanide poisoning of the nature observed in most patients in this study is frequently fatal. That 71% of patients survived after treatment with hydroxocobalamin suggests that hydroxocobalamin as first-line antidotal therapy is effective and safe in acute cyanide poisoning.