J Korean Med Assoc.  2013 Dec;56(12):1076-1083. 10.5124/jkma.2013.56.12.1076.

Antidotes of cyanide intoxication

• Lee SW
• Kim JS

• KMID: 1783722
• DOI: http://doi.org/10.5124/jkma.2013.56.12.1076

Abstract

Cyanide poisoning can occur from industrial disasters, smoke inhalation from fire, food, and multiple other sources. Cyanide inhibits mitochondrial oxidative phosphorylation by blocking mitochondrial cytochrome oxidase, which in turn results in anaerobic metabolism and depletion of adenosine triphosphate in cells. Rapid administration of antidote is crucial for life saving in severe cyanide poisoning. Multiple antidotes are available for cyanide poisoning. The action mechanism of cyanide antidotes include formation of methemoglobin, production of less or no toxic complex, and sulfane sulfur supplementation. At present, the available antidotes are amyl nitrite, sodium nitrite, sodium thiosulfate, hydroxocobalamin, 4-dimethylaminophenol, and dicobalt edetate. Amyl nitrite, sodium nitrite, and 4-dimethylaminophenol induce the formation of methemoglobin. Sodium thiosulfate supplies the sulfane sulfur molecule to rhodanese, allowing formation of thiocyanate and regeneration of native enzymes. Hydroxocobalamin binds cyanide rapidly and irreversibly to form cyanocobalamin. Dicobalt edetate acts as a chelator of cyanide, forming a stable complex. Based on the best evidence available, a treatment regimen of 100% oxygen and hydroxocobalamin, with or without sodium thiosulfate, is recommended for cyanide poisoning. Amyl nitrite and sodium nitrite, which induce methemoglobin, should be avoided in victims of smoke inhalation because of serious adverse effects.

Keyword

Cyanide; Cyanide antidote; Sodium thiosulfate; Hydroxocobalamin

MeSH Terms

Adenosine Triphosphate
Aminophenols
Amyl Nitrite
Antidotes*
Disasters
Edetic Acid
Electron Transport Complex IV
Equipment and Supplies
Fires
Hydroxocobalamin
Inhalation
Metabolism
Methemoglobin
Oxidative Phosphorylation
Oxygen
Poisoning
Polyphosphates
Regeneration
Smoke
Sodium
Sodium Nitrite
Sulfur
Thiocyanates
Thiosulfate Sulfurtransferase
Thiosulfates
Vitamin B 12
Adenosine Triphosphate
Aminophenols
Amyl Nitrite
Antidotes
Edetic Acid
Electron Transport Complex IV
Hydroxocobalamin
Methemoglobin
Oxygen
Polyphosphates
Smoke
Sodium
Sodium Nitrite
Sulfur
Thiocyanates
Thiosulfate Sulfurtransferase
Thiosulfates
Vitamin B 12

Figure

• 

  Figure 1 Natural pathway for cyanide (CN) detoxification. α-kgCN, alpha-ketoglutarate cyanohydrin

• 

  Figure 2 Action mechanisms of cyanide (CN) antidotes. CN-reversibly bind with mitochondrial cytochrome a3 and then inhibit cellular respiration. CN antidotes detoxify cyanide by formation of less or no toxic compounds. CoCN, cyanocobalamine; CNMetHb, cyanide-methemoglobin.

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