Annals of Emergency Medicine
Volume 49, Issue 6 , Pages 794-801.e2 , June 2007

Prospective Study of Hydroxocobalamin for Acute Cyanide Poisoning in Smoke Inhalation

Presented in part at the 2005 annual meeting of the American College of Emergency Physicians, September 2005, Washington, DC.

  • Stephen W. Borron, MD

      Affiliations

    • Division of Emergency Medicine, University of Texas Health Science Center, San Antonio, TX
  • ,
  • Frédéric J. Baud, MD

      Affiliations

    • Assistance Publique-Hôpitaux de Paris, Medical and Toxicological Critical Care Department, Fernand Widal-Lariboisière Hospital, University de Paris 7, Paris, France
    • Corresponding Author InformationAddress for correspondence: Frédéric J. Baud, MD, Medical and Toxicological Critical Care Department, Hospital Lariboisière, 2 rue Ambroise Paré, 75010 Paris, France; 33 1 49 95 64 91, fax 33 1 49 95 65 78
  • ,
  • Patrick Barriot, MD

      Affiliations

    • Département Risques Chimiques et Technologiques, Saint-Cloud Cedex, France
  • ,
  • Michel Imbert, MD

      Affiliations

    • HIA Laveran, Service d’Anesthésie, Marseille, France.
  • ,
  • Chantal Bismuth, MD

      Affiliations

    • Assistance Publique-Hôpitaux de Paris, Medical and Toxicological Critical Care Department, Fernand Widal-Lariboisière Hospital, University de Paris 7, Paris, France

Received 11 October 2006 ,Revised 15 January 2007 ,Accepted 29 January 2007.

References 

  1. US Fire Administration/National Fire Data Center. Fire risk. Topical Fire Res Series. 2004;7:1–6
  2. In:  Krug E editors. Injury: A Leading Cause of the Global Burden of Disease. Geneva, Switzerland: World Health Organization; 1999;WHO document WHO/HSC/PVI/99.11.
  3. Alarie Y. Toxicity of fire smoke. Crit Rev Toxicol. 2002;32:259–289
  4. Eckstein M, Maniscalco P. Focus on smoke inhalation—the most common cause of acute cyanide poisoning. Prehospital Disaster Med. 2006;21(2 suppl 2):s49–s55
  5. Walsh DW, Eckstein M. Hydrogen cyanide in fire smoke: an underappreciated threat. Emerg Med Serv. 2004;10:160–163
  6. Baud FJ, Barriot P, Toffis V, et al. Elevated blood cyanide concentrations in victims of smoke inhalation. N Engl J Med. 1991;325:1761–1766
  7. Mégarbane B, Delahaye A, Goldgran-Tolédano D, et al. Antidotal treatment of cyanide poisoning. J Chin Med Assoc. 2003;66:193–203
  8. Gracia R, Shepherd G. Cyanide poisoning and its treatment. Pharmacotherapy. 2004;24:1358–1365
  9. Sauer SW, Keim ME. Hydroxocobalamin: improved public health readiness for cyanide disasters. Ann Emerg Med. 2001;37:635–641
  10. Jones J, McMullen MJ, Dougherty J. Toxic smoke inhalation: cyanide poisoning in fire victims. Am J Emerg Med. 1987;5:317–321
  11. Becker CE. The role of cyanide in fires. Vet Hum Toxicol. 1985;27:487–490
  12. Hall AH, Kulig KW, Rumack BH. Suspected cyanide poisoning in smoke inhalation: complications of sodium nitrite therapy. J Toxicol Clin Exp. 1989;9:3–9
  13. Fortin JL, Ruttiman M, Domanski L, et al. Hydroxocobalamin: treatment for smoke inhalation-associated cyanide poisoning. Meeting the needs of fire victims. JEMS. 2004;29(suppl):18–21
  14. Fortin J-L, Giocanti J-P, Ruttimann M, et al. Prehospital administration of hydroxocobalamin for smoke inhalation-associated cyanide poisoning: 8 years of experience in the Paris Fire Brigade. Clin Toxicol. 2006;44(suppl 1):37–44
  15. Bromley J, Hughes BG, Leong DC, et al. Life-threatening interaction between complementary medicines: cyanide toxicity following ingestion of amygdalin and vitamin C. Ann Pharmacother. 2005;39:1566–1569
  16. Fortin JL, Waroux S, Ruttimann M, et al. Hydroxocobalamin for poisoning caused by ingestion of potassium cyanide: a case study. [abstract] Clin Toxicol. 2005;43:731
  17. Weng TI, Fang CC, Lin SM, et al. Elevated plasma cyanide level after hydroxocobalamin infusion for cyanide poisoning. Am J Emerg Med. 2004;22:492–493
  18. Bismuth C, Baud FJ, Djeghout H, et al. Cyanide poisoning from propionitrile exposure. J Emerg Med. 1987;5:191–195
  19. Mannaioni G, Vannacci A, Marzocca C, et al. Acute cyanide intoxication treated with a combination of hydroxycobalamin, sodium nitrite, and sodium thiosulfate. J Toxicol Clin Toxicol. 2002;40:181–183
  20. Gourlain H, Laforge M, Buneaux F, et al. Risk of underestimating blood carbon monoxide by certain analytic methods. Presse Med. 1999;28:163–167
  21. Marbach EP, Weil MH. Rapid enzymatic measurement of blood lactate and pyruvate. Clin Chem. 1967;13:314–325
  22. Benaissa ML, Mégarbane B, Borron SW, et al. Is elevated plasma lactate a useful marker in the evaluation of pure carbon monoxide poisoning?. Intensive Care Med. 2003;29:1372–1375
  23. Rieders F. Cyanide. In:  Sunshine J editors. Methodology for Analytical Toxicology. Vol. 1:Cleveland, OH: CRC Press; 1975;p. 113–118
  24. Moureu H, Chovin P, Truffert L, et al. New micromethod for rapid and precise determination of carbon monoxide in blood, by selective absorption in the infrared spectrum. Arch Mal Prof. 1957;18:116–124
  25. Pace N, Consolazio WV, White WA, et al. Formulation of the principle factors affecting the rate of uptake of carbon monoxide by man. Am J Physiol. 1946;147:352–359
  26. Baud FJ, Borron SW, Mégarbane B, et al. Value of lactic acidosis in the assessment of the severity of acute cyanide poisoning. Crit Care Med. 2002;30:2044–2050
  27. Kirk MA, Gerace R, Kulig KW. Cyanide and methemoglobin kinetics in smoke inhalation victims treated with the cyanide antidote kit. Ann Emerg Med. 1993;22:1413–1418
  28. Forsyth JC, Mueller PD, Becker CE, et al. Hydroxocobalamin as a cyanide antidote: safety, efficacy and pharmacokinetics in heavily smoking normal volunteers. Clin Toxicol. 1993;31:277–294
  29. Uhl W, Nolting A, Golor G, et al. Safety of hydroxocobalamin in healthy volunteers in a randomized, placebo-controlled study. Clin Toxicol. 2006;44(suppl 1):17–28
  30. Gerth K, Ehring T, Braendle M, et al. Nitric oxide scavenging by hydroxocobalamin may account for its hemodynamic profile. Clin Toxicol. 2006;44(suppl 1):29–36
  31. Greenberg SS, Xie J, Zatarain JM, et al. Hydroxocobalamin (vitamin B12a) prevents and reverses endotoxin-induced hypotension and mortality in rodents: role of nitric oxide. J Pharmacol Exp Ther. 1995;273:257–265
  32. Cummings TG. The treatment of cyanide poisoning. Occup Med. 2004;54:82–85
  33. Curry SC, Connor DA, Raschke RA. Effect of the cyanide antidote hydroxocobalamin on commonly ordered serum chemistry studies. Ann Emerg Med. 1994;24:65–67
  34. Gourlain H, Caliez C, Laforge M, et al. Study of the mechanisms involved in hydroxocobalamin interference with determination of some biochemical parameters. Ann Biol Clin (Paris). 1994;52:121–124
  35. Branco-Ferreira M, Clode MH, Pereira-Barbosa MA, et al. Anaphylactic reaction to hydroxycobalamin. Allergy. 1997;52:118–119
  36. Heyworth-Smith D, Hogan PG. Allergy to hydroxycobalamin, with tolerance of cyanocobalamin. Med J Aust. 2002;177:162–163
  37. EMD data on file, 2006.

 Supervising editor: E. Martin Caravati, MD, MPHAuthor contributions: All authors contributed to the design, conduct, or analysis of the study and the preparation of the article, and all approved the final version for submission. FJB takes responsibility for the paper as a whole.Funding and support: Data analysis for this study and medical writing assistance with the article were supported by EMD Pharmaceuticals, an affiliate of Merck KgaA. No pharmaceutical company was involved, financially or otherwise, in the design or conduct of the study. Drs. Baud and Borron have been consultants for EMD Pharmaceuticals.Reprints not available from the authors.

PII: S0196-0644(07)00217-X

doi: 10.1016/j.annemergmed.2007.01.026

Annals of Emergency Medicine
Volume 49, Issue 6 , Pages 794-801.e2 , June 2007