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Cyanide Poisoning and Hydroxocobalamin

Cyanide intoxication and antidote management with hydroxocobalamin.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Acil Servis department. Book Appointment →

What is Cyanide Poisoning and Hydroxocobalamin?

Cyanide poisoning develops via inhibition of cytochrome c oxidase in the mitochondrial electron transport chain. Aerobic metabolism is interrupted, anaerobic metabolism becomes dominant and severe lactic acidosis develops.

Major exposure sources include smoke inhalation in fires, industrial accidents, suicide attempts, ingestion of plants containing cyanogenic glycosides (apricot kernels, bitter almond) and prolonged sodium nitroprusside infusion.

Hydroxocobalamin (vitamin B12a) is the first-line antidote in fire-related cyanide poisoning, binding cyanide to form cyanocobalamin which is excreted in the urine. It is preferred over the cyanide kit when smoke inhalation and methaemoglobinaemia coexist.

Symptoms

Sudden loss of consciousness
Severe metabolic acidosis (lactate >8 mmol/L)
Cardiac arrest or arrhythmia
Respiratory distress
Cherry red mucous membranes
Bitter almond breath odour (60% sensitive)
Convulsions and coma

Risk Factors

Smoke inhalation in fires
Cyanide-related industrial accident
Suicide attempt with cyanide salts
Prolonged sodium nitroprusside infusion
Ingestion of bitter almond and apricot kernels
Cassava processing in selected geographies
Laboratory and chemistry workers

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Sudden loss of consciousness in fire victims and severe acidosis
  • Findings of intoxication after suspected industrial cyanide exposure
  • Cyanide ingestion or suicide attempt
  • Acidosis and clinical deterioration during nitroprusside infusion

Treatment Methods

01
Immediate hydroxocobalamin 5 g intravenously over 15 min (repeat dose if needed)
02
100% oxygen and intubation if needed
03
Sodium thiosulfate 12.5 g IV adjuvant
04
Cyanide kit (amyl nitrite, sodium nitrite, sodium thiosulfate) — alternative
05
Treatment of metabolic acidosis (sodium bicarbonate)
06
Cardiopulmonary support and ECMO when indicated
07
Decontamination and removal from the source

Which Department to Visit?

You can visit our Acil Servis department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.