Quimica

A Review of Acute Cyanide Poisoning With a Treatment Update
Jillian Hamel
Crit Care Nurse 2011;31:72-82 doi: 10.4037/ccn2011799
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Toxicology

A Review of Acute Cyanide Poisoning With a Treatment Update
Jillian Hamel, MS, ACNP-BC, CCNS, CCRN
Cyanide causes intracellular hypoxia by reversibly binding tomitochondrial cytochrome oxidase a3. Signs and symptoms of cyanide poisoning usually occur less than 1 minute after inhalation and within a few minutes after ingestion. Early manifestations include anxiety, headache, giddiness, inability to focus the eyes, and mydriasis. As hypoxia progresses, progressively lower levels of consciousness, seizures, and coma can occur. Skin may look normal or slightlyashen, and arterial oxygen saturation may be normal. Early respiratory signs include transient rapid and deep respirations. As poisoning progresses, hemodynamic status may become unstable. The key treatment is early administration of 1 of the 2 antidotes currently available in the United States: the well-known cyanide antidote kit and hydroxocobalamin. Hydroxocobalamin detoxifies cyanide by bindingwith it to form the renally excreted, nontoxic cyanocobalamin. Because it binds with cyanide without forming methemoglobin, hydroxocobalamin can be used to treat patients without compromising the oxygencarrying capacity of hemoglobin. (Critical Care Nurse. 2011;31[1]:72-82)

A

patient who has occupational access to cyanide arrives in the intensive care unit (ICU) after ingesting the compound inan apparent suicide attempt.

CEContinuing Education
This article has been designated for CE credit. A closed-book, multiple-choice examination follows this article, which tests your knowledge of the following objectives: 1. Understand the pathophysiology of acute cyanide poisoning 2. Recognize the importance of immediate antidote administration in the setting of acute cyanide poisoning 3.Differentiate the 2 available acute cyanide poisoning antidotes ©2011 American Association of CriticalCare Nurses doi: 10.4037/ccn2011799

Although initially awake when emergency technicians were called to the scene, the patient became unresponsive and pulseless en route. After 2 rounds of cardiopulmonary resuscitation and injections of epinephrine and atropine, the patient has regained a pulse. Atthe hospital, the emergency department team administers hydroxocobalamin and a sedative, intubates the patient, and transfers him to the ICU. The complex process of managing a patient with acute cyanide poisoning begins as the critical care nurse notes the patient has cool, gray skin; blood pressure 100/50 mm Hg; heart rate 128/min; and oxygen saturation 98% on 100% fraction of inspired oxygen.Knowledge of the pathophysiology of acute cyanide poisoning and its antidotes in combination with the ability to tailor management of a patient’s care to this unique situation will be critical to the patient’s recovery. In this article, I discuss the pathophysiology of acute cyanide poisoning and detail the benefits and challenges of the antidotes currently available. Life-threatening cyanide...