After completion of CN infusion, NaNO 2 was infused to induce methemoglobinemia (MetHb).
DOS and concurrent physiologic measurements were obtained. A sodium CN solution was infused intravenously. To perform experiments, the DOS probe was placed on the hind leg of rabbits. DOS was ased to optically monitor CN toxicity and treatment with sodium nitrite (NaNO 2). We developed a broadband diffuse optical spectroscopy (DOS) system to measure bulk tissue absorption and scattering. The standard 5 g dose should be sufficient without needing to re-dose.ĭon’t forget to draw labs BEFORE starting the infusion, since hydroxocobalamin will interfere with the results of labs that rely on the use of colorimetric probes, which includes your carboxyhemoglobin level, as well as lactate and certain LFTs.Currently, no reliable noninvasive methods exist for monitoring the severity of in vivo cyanide (CN) toxicity, treatment, and resulting physiological changes. Rock (do not shake) the vial back and forth for 60 seconds to mix. You will need to grab a bag of 0.9% normal saline. And increased tissue hypoxia via the production of Met-Hgb compounded by carbon monoxide -induced tissue hypoxia = BAD.ģ) Quick! How is the Cyanokit administered?Įach kit contains a vial with 5 g of hydroxocobalamin in powdered form, IV tubing, transfer spike and instruction card. We know that Met-Hgb shifts the oxygen dissociation curve to the left, causing decreased oxygen delivery to the tissues. Stay with me, people, we’re almost done…. Cyanide, which throws a wrench in oxidative metabolism by binding with cytochrome oxidase via the electron transport chain, preferentially binds to Met-Hgb over cytochrome oxidase.
One of these two kits is contraindicated in patients with cyanide poisoning in whom there is a concomitant concern for carbon monoxide poisoning (ie: patients involved in home/commercial fires or smoke inhalation victims- the most common presentation for cyanide toxicity).Īnd why is this so? These two kits contain two completely different active compounds that work to clear cyanide by two completely different mechanisms.Ĭyanokit: Cyanide displaces the extra hydroxyl group on B12 to form cyanocobalamin, which is excreted by the kidneys.Ĭyanide Antidote Kit: sodium nitrite (or any other kit utilizing nitrites) reacts with hemoglobin to form methemoglobin (met-hgb). It contains amyl nitrite and sodium thiosulfate. The other most commonly distributed kit is aptly named the Cyanide Antidote Kit. It is one of two main antidote kits in circulation for treatment of cyanide poisoning. The Cyanokit contains hydroxocobalamin (HCN), which is essentially Vitamin B12 + an extra hydroxyl group. 1) Name the active ingredient in the Cyanokit.
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