hydroxocobalamin and Acute-Disease

To review the recently approved cyanide antidote, hydroxocobalamin, and describe its role in therapy.. Relevant publications were identified through a systematic search of PubMed using the MeSH terms and key words hydroxocobalamin and cyanide. This search was then limited to human studies published since 2000. Systematic searches were conducted through January 2008. References from identified articles were reviewed for additional pertinent human studies.. The literature search retrieved 7 studies on the safety and/or efficacy of hydroxocobalamin in humans. Four new studies were identified by the search and 3 studies were identified from the references.. Studies of antidote efficacy in humans are ethically and logistically difficult. A preclinical study demonstrated that intravenous doses of hydroxocobalamin 5 g are well tolerated by volunteer subjects. Hydroxocobalamin has been shown to reduce cyanide concentrations in controlled studies of nitroprusside therapy and in heavy smokers. A retrospective study of 14 acute cyanide poisonings also demonstrated hydroxocobalamin's safety and efficacy. Two studies examining hydroxocobalamin for smoke inhalation-associated cyanide poisoning indicated a possible benefit, but they are insufficient to establish definitive criteria for use in this setting. Randomized controlled trials of hydroxocobalamin and traditional cyanide antidotes (nitrites/thiosulfate) are lacking.. Cyanide poisoning can rapidly cause death. Having an effective antidote readily available is essential for facilities that provide emergency care. In cases of cyanide ingestion, both the nitrite/thiosulfate combination and hydroxocobalamin are effective antidotes. Hydroxocobalamin offers an improved safety profile for children and pregnant women. Hydroxocobalamin also appears to have a better safety profile in the setting of cyanide poisoning in conjunction with smoke inhalation. However, current data are insufficient to recommend the empiric administration of hydroxocobalamin to all victims of smoke inhalation.

Topics: Acute Disease; Antidotes; Cyanides; Humans; Hydroxocobalamin; Inhalation Exposure; Retrospective Studies

Topics: Acute Disease; Adult; Aftercare; Amyl Nitrite; Antidotes; Cyanides; Decontamination; Emergency Medical Services; Emergency Nursing; Emergency Treatment; Humans; Hydroxocobalamin; Life Support Care; Male; Nurse's Role; Parkinsonian Disorders; Poisoning; Sodium Nitrite; Suicide, Attempted; Thiosulfates; Triage

Poisoning by gases in our area is an important problem due to its high incidence. In the specific case of carbon monoxide poisoning, this is the main cause of death by poisoning in our environment, on many occasions coexisting with cyanide poisoning. Both poisonings can be severe, their diagnosis being based on the mere suspicions of the doctor. Besides, their importance lies in the fact that both poisonings have a very specific treatment. Normo or hyperbaric oxygenotherapy is the treatment for carbon monoxide poisoning. In the case of cyanide poisoning, hydroxocobalamin is nowadays the treatment of choice, since it has proved itself to be an efficient antidote.

Topics: Acute Disease; Carbon Monoxide Poisoning; Cyanides; Hematinics; Humans; Hydroxocobalamin; Hyperbaric Oxygenation

Topics: Acute Disease; Antidotes; Cyanides; Humans; Hydroxocobalamin; Thiosulfates

Severe, acute cyanide poisoning is uncommon and can be very difficult to diagnose if a history of exposure is unavailable. Victims of smoke inhalation may have significant cyanide poisoning as well as carbon monoxide toxicity. The Lilly Cyanide Antidote Kit currently available in America unfortunately has its own inherent toxicity. An efficacious antidote lacking toxicity is desirable, especially in cases where the diagnosis of cyanide poisoning cannot be made with certainty. Hydroxycobalamin/sodium thiosulfate has been used in France since 1970. Both components have been shown to be safe and efficacious in animal studies. Case reports of human cyanide poisoning treated with hydroxycobalamin/sodium thiosulfate have been published only in French. Animal and human data on the use of this antidotal combination are reviewed. Hydroxycobalamin/sodium thiosulfate is an efficacious cyanide antidote with little inherent toxicity.

Topics: Acute Disease; Antidotes; Cyanides; Drug Synergism; Drug Therapy, Combination; Humans; Hydroxocobalamin; Thiosulfates

This randomized, controlled, double-blind clinical study in parallel groups evaluated the safety and efficacy of an oral combination diclofenac-cholestyramine, nucleotides (uridine and cytidine) and vitamin B12 versus the oral combination of nucleotides and vitamin B12 in the treatment of acute, non-traumatic pain. Subjects received twice-daily, 10-day oral administration of diclofenac-cholestyramine + uridine + cytidine + vitamin B12 (Group DN, n=40) or uridine + cytidine + vitamin B12 (Group NB, n=41). The primary study endpoint was the number of subjects with VAS reduction of >30mm after 10 days of treatment. Secondary endpoints included the number of patients with improvement >5 points in the Patient Functionality Questionnaire after 10 days of treatment, and the number of subjects presenting adverse events. Treatment with the combination of diclofenac-cholestyramine, nucleotides and Vitamin B12 resulted in a higher number of subjects with VAS score reductions >30mm after 10 days of treatment (87.5% subjects) than in the control group administered nucleotides and Vitamin B12 (51.23% of subjects), (p>0.0006). A significantly higher number of subjects in the DN group (80%) had a score reduction of >5 points in the Patient Functionality Questionnaire at after 10 days of treatment compared to Group NB (29.3%), (p<0.001). The number of subjects presenting AEs did not vary significantly between treatment groups (p=0.587). The combination of diclofenac-cholestyramine with uridine, cytidine and vitamin B12 was well-tolerated over a 10-day treatment period. The combination reduced pain and improved functionality among subjects presenting acute, non-traumatic pain in the lower back, hips, and neck.

Topics: Acute Disease; Adult; Anti-Inflammatory Agents, Non-Steroidal; Cholestyramine Resin; Cytidine Monophosphate; Diclofenac; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Hydroxocobalamin; Male; Middle Aged; Pain; Uridine Triphosphate

Clinical experience with hydroxocobalamin in acute cyanide poisoning via ingestion remains limited. This case concerns a 35-year-old mentally ill woman who consumed more than 20 apricot kernels. Published literature suggests each kernel would have contained cyanide concentrations ranging from 0.122 to 4.09 mg/g (average 2.92 mg/g). On arrival, the woman appeared asymptomatic with a raised pulse rate and slight metabolic acidosis. Forty minutes after admission (approximately 70 min postingestion), the patient experienced headache, nausea and dyspnoea, and was hypotensive, hypoxic and tachypnoeic. Following treatment with amyl nitrite and sodium thiosulphate, her methaemoglobin level was 10%. This prompted the administration of oxygen, which evoked a slight improvement in her vital signs. Hydroxocobalamin was then administered. After 24 h, she was completely asymptomatic with normalised blood pressure and other haemodynamic parameters. This case reinforces the safety and effectiveness of hydroxocobalamin in acute cyanide poisoning by ingestion.

Topics: Acute Disease; Adult; Female; Hematinics; Humans; Hydrogen Cyanide; Hydroxocobalamin; Poisoning; Prunus; Seeds; Treatment Outcome

Topics: Acute Disease; Animals; Antidotes; Clinical Trials as Topic; Cyanides; Drug Evaluation, Preclinical; Emergency Medical Services; Humans; Hydroxocobalamin; Poisoning

The efficacy of hydroxocobalamin for acute cyanide poisoning was compared with that of saline vehicle in dogs.. Anesthetized adult beagle dogs were administered potassium cyanide (0.4 mg/kg/min, IV) until 3 min after the onset of apnea. Hydroxocobalamin (75 mg/kg [n = 19] or 150 mg/kg [n = 18], IV) or saline vehicle [n = 17] was then infused over 7.5 min while animals were ventilated with 100% oxygen, which was stopped after 15 min.. In vehicle-treated animals cyanide produced deterioration that culminated in a moribund state requiring euthanasia within 4 h in 10 of 17 animals and in neurological deficits necessitating euthanasia within 2-4 d in an additional 4 animals (mortality rate 82%). Survival through 14 d was observed in 15 of 19 animals administered hydroxocobalamin 75 mg/kg (mortality rate 21%), and 18 of 18 administered hydroxocobalamin 150 mg/kg (mortality rate 0%).. Hydroxocobalamin reversed cyanide toxicity and reduced mortality in a canine model.

Topics: Acute Disease; Animals; Antidotes; Blood Pressure; Dogs; Dose-Response Relationship, Drug; Female; Heart Rate; Hemodynamics; Hydroxocobalamin; Lactic Acid; Male; Models, Animal; Neurologic Examination; Poisoning; Potassium Cyanide; Random Allocation; Respiratory Function Tests; Sodium Chloride

Topics: Acute Disease; Antidotes; Humans; Hydroxocobalamin; Poisoning; Potassium Cyanide

Topics: Acute Disease; Animals; Cyanides; Hydroxocobalamin; Male; Rats; Rats, Inbred Strains

A 64-year-old woman developed an acute organic psychosis secondary to thyrotoxicosis and B12 deficiency, without the overt clinical features of pernicious anemia. The psychosis resolved with B12 and thyroid hormone replacement. The patient relapsed after an erroneous iatrogenic tripling of the levothyroxine dosage, but her condition normalized after dosage correction.

Topics: Acute Disease; Female; Folic Acid; Humans; Hydroxocobalamin; Hyperthyroidism; Middle Aged; Neurocognitive Disorders; Thyroxine; Vitamin B 12 Deficiency

Topics: Acute Disease; Amyl Nitrite; Cyanides; Edetic Acid; Humans; Hydroxocobalamin; Nitrates; Thiosulfates

Topics: Acute Disease; Adult; Antidotes; Child, Preschool; Emergencies; Female; Humans; Hydrogen Cyanide; Hydroxocobalamin; Male; Middle Aged; Poisoning