hydroxocobalamin and Carbon-Monoxide-Poisoning

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

A middle-aged patient presented with toxic inhalational injury, and was resuscitated prehospitally and treated in the emergency department for smoke inhalation, carbon monoxide (CO) exposure and cyanide poisoning with the use of antidotes. Due to the CO effects on spectrophotometry, an anaemia initially identified on blood gas analysis was thought to be artefactual, but was later confirmed by laboratory testing to be accurate. In addition, cyanide can confound haemoglobin testing due to its use in the analytical process and non-cyanide analysis is required when there is suspected exposure. Although no consensus exists on a first-line cyanide antidote choice, hydroxocobalamin is the only antidote without a serious side effect profile and/or deleterious cardiovascular effects. We propose prehospital enhanced care teams consider carrying hydroxocobalamin for early administration in toxic inhalational injury.

Topics: Administration, Intravenous; Antidotes; Blood Gas Analysis; Carbon Monoxide Poisoning; Cyanides; Fatal Outcome; Humans; Hydroxocobalamin; Male; Middle Aged; Out-of-Hospital Cardiac Arrest; Smoke Inhalation Injury

Carbon monoxide and cyanide poisoning are important causes of death due to fire. Carbon monoxide is more regularly assessed than cyanide at the site of burn or smoke inhalation treatment due to its ease in assessment and simplicity to treat. Although several forensic studies have demonstrated the significance of cyanide poisoning in fire victims using blood cyanide levels, the association between the cause of cardiac arrest and the concentration of cyanide among fire victims has not been sufficiently investigated. This study aimed to investigate the frequency of cyanide-induced cardiac arrest in fire victims and to assess the necessity of early empiric treatment for cyanide poisoning.. This study was a retrospective analysis of fire victims with cardiac arrest at the scene who were transported to a trauma and critical care center, Kyorin University Hospital, from January 2014 to June 2017. Patients whose concentration of cyanide was measured were included.. Five patients were included in the study; all died despite cardiopulmonary resuscitation. Three of these victims were later found to have lethal cyanide levels (>3 μg/ml). Two of the patients had non-lethal carboxyhemoglobin levels under 50% and might have been saved if hydroxocobalamin had been administered during resuscitation.. According to our results, cyanide-induced cardiac arrest may be more frequently present among fire victims than previously believed, and early empiric treatment with hydroxocobalamin may improve outcomes for these victims in cases where cardiac arrest is of short duration.

Topics: Aged; Carbon Monoxide Poisoning; Carboxyhemoglobin; Cyanides; Female; Fires; Humans; Hydroxocobalamin; Male; Middle Aged; Out-of-Hospital Cardiac Arrest; Smoke Inhalation Injury

Topics: Aged, 80 and over; Antidotes; Carbon Monoxide Poisoning; Cyanides; Humans; Hydroxocobalamin; Male; Pigmentation Disorders; Plasma

Current management of acute inhalational carbon monoxide (CO) toxicity includes hyperbaric or normobaric O2 therapy. However, efficacy has not been established. The purpose of this study was to establish therapeutic proof of concept for a novel injectable antidote consisting of the combination of hydroxocobalamin and ascorbic acid into a reduced form (B12r) as demonstrated by clinically significant increase (>500 ppm) in CO2 production, reduced carboxyhemoglobin (COHgb) half-life (COHgb t1/2), and increased cerebral O2 delivery and attenuation of CO-induced microglial damage in a preclinical rodent model of CO toxicity.. B12r-mediated conversion of CO to CO2 and COHgb t1/2 in human blood were measured by gas analysis and Raman resonance spectroscopy. Rats were exposed to either air or CO and then injected with saline or B12r. Cognitive assessment was tested in a Morris water maze. Brain oxygenation was measured with Licox. Brain histology was assessed by fluorescent antibody markers and cell counts.. B12r resulted in significant CO2 production (1,170 ppm), compared with controls. COHgb t1/2 was reduced from 33 minutes (normal saline) to 17.5 (p < 0.001). In rat models, severe CO-induced brain hypoxia (PbtO2, 18 mm Hg) was followed by significant reduction in τ25 to 12 minutes for B12r rats versus 40 minutes for normal saline-treated rats (p < 0.0001). There was major attenuation of CO-induced microglial damage, although cognitive performance differences were minimal.. Our preclinical data suggest that the novel synergism of hydroxocobalamin with ascorbic acid has the potential to extract CO through conversion to CO2, independently of high-flow or high-pressure O2. This resulted in a clinically significant off-gassing of CO2 at levels five to eight times greater than those of controls, a clinically significant reduction in COHgb half-life, and evidence of increased brain oxygenation and amelioration of myoglial damage in rat models. Reduced hydroxocobalamin has major potential as an injectable antidote for CO toxicity.

Topics: Animals; Antidotes; Ascorbic Acid; Carbon Monoxide Poisoning; Humans; Hydroxocobalamin; Immunohistochemistry; In Vitro Techniques; Male; Maze Learning; Microscopy, Confocal; Oxygen Inhalation Therapy; Rats; Rats, Long-Evans; Rats, Sprague-Dawley; Spectrum Analysis, Raman

Topics: Antidotes; Artifacts; Carbon Monoxide Poisoning; Craniocerebral Trauma; Fires; Firesetting Behavior; Hematuria; Humans; Hydrogen Cyanide; Hydroxocobalamin; Male; Middle Aged; Multiple Trauma; Smoke Inhalation Injury; Suicide, Attempted; Urinalysis; Wounds, Gunshot

Topics: Animals; Antidotes; Carbon Monoxide Poisoning; Humans; Hydrogen Cyanide; Hydroxocobalamin; Poisoning; Smoke Inhalation Injury

Concentrated aqueous solutions of hydroxocobalamin (OHCob) are administered intravenously for cyanide poisoning victims, many of whom also have concurrent smoke inhalation. Because of its intense light absorbance in visible wavelengths (absorption peak at 532 nm), we investigate potential interference effects of OHCob on total hemoglobin concentration (tHb), carboxyhemoglobin (COHb), methemoglobin (MetHb), and oxyhemoglobin (Hb-O2) cooximetry measurement values in blood.. In vivo cooximetry measurements were conducted with 3 specific pathogen-free white New Zealand rabbits (3.80+/-0.21 kg) during the intravenous infusion of OHCob (625 mg during a 100-minute period). Resultant changes in tHb, Hb-O2, COHb, and MetHb values were measured and correlated with respect to estimated in vivo OHCob concentrations. In vitro measurements were conducted with rabbit blood to confirm in vivo measurements.. The introduction of OHCob clearly interfered with the cooximetry measurements of each of the hemoglobin component fractions in whole blood and resulted in altered measurement values from the baseline values. The presence of OHCob in blood interferes with cooximetry measurements of COHb, MetHb, and Hb-O2. The increase in measured COHb fraction with increasing concentrations of OHCob was most notable.. The presence of OHCob in blood interferes with cooximetry measurements of COHb, MetHb, and Hb-O2. These effects need to be considered during OHCob treatment of cyanide poisoning, particularly in smoke inhalation victims with potential for concurrent carbon monoxide exposure, because it may lead to potentially erroneous reported COHb levels.

Topics: Animals; Antidotes; Carbon Monoxide Poisoning; Carboxyhemoglobin; Hemoglobins; Hydrogen Cyanide; Hydroxocobalamin; In Vitro Techniques; Infusions, Intravenous; Methemoglobin; Oximetry; Oxyhemoglobins; Rabbits; Smoke Inhalation Injury; Vitamin B Complex

Topics: Antidotes; Carbon Monoxide Poisoning; Cyanides; Drug Therapy, Combination; Humans; Hydroxocobalamin; Poisoning; Sodium Nitrite

Topics: Autonomic Nervous System Diseases; Barbiturates; Biomedical Research; Blood Chemical Analysis; Carbon Monoxide Poisoning; Cerebrovascular Disorders; Chemical Phenomena; Chemistry; Humans; Hydroxocobalamin; Mental Disorders; Neuralgia; Neuritis; Neurology; Pharmacology; Poisoning; Vitamin B 12