sodium-nitrite and Burns

The importance of cyanide toxicity as a component of inhalational injury in patients with burns is increasingly being recognised, and its prompt recognition and management is vital for optimising burns survival. The evidence base for the use of cyanide antidotes is limited by a lack of randomised controlled trials in humans, and in addition consideration must be given to the concomitant pathophysiological processes in patients with burns when interpreting the literature. We present a literature review of the evidence base for cyanide antidotes with interpretation in the context of patients with burns. We conclude that hydroxycobalamin should be utilised as the first-line antidote of choice in patients with burns with inhalational injury where features consistent with cyanide toxicity are present.

Topics: Adenosine; Amyl Nitrite; Burns; Chelating Agents; Cyanides; Edetic Acid; Humans; Hydroxocobalamin; Hyperbaric Oxygenation; Oxygen Inhalation Therapy; Poisoning; Pteridines; Smoke Inhalation Injury; Sodium Nitrite; Thiosulfates

Topics: Abdominal Injuries; Burns; Burns, Chemical; Eating; Humans; Methemoglobinemia; Sodium Nitrite; Thoracic Injuries

A full-thickness burn wound model was used to evaluate the effects of a topically applied gel-based nitric oxide donor on wound healing in rats. The histological study demonstrated that the nitric oxide (NO) application significantly promoted re-epithelization that resulted in a fast recovery of burn wound. The histological sections further revealed that inflammatory cell infiltration in the NO-treated group was significantly increased in comparison to the control group. The enhanced accumulation of inflammatory cells resulted in a higher expression of myeloperoxidase (MPO) that was detected with imunoblotting. An immunohistochemistry study with CD31, a specific marker for endothelial cells, indicated that NO treatment markedly stimulated angiogenesis. Evaluation of collagen synthesis by immunohistochemistry with procollagen antibody demonstrated a significantly increased collagen synthesis in NO-treated wound bed. We concluded that NO treatment promoted re-epithelialization and wound closure by means of enhanced inflammatory cell infiltration, and that it promoted angiogenesis and facilitated collagen synthesis in the wound bed.

Topics: Administration, Topical; Animals; Blotting, Western; Burns; Disease Models, Animal; Gels; Immunoenzyme Techniques; Male; Neovascularization, Physiologic; Nitric Oxide; Peroxidase; Rats; Rats, Sprague-Dawley; Sodium Nitrite; Wound Healing

Topics: Ammonium Compounds; Anti-Infective Agents, Local; Burns; Humans; Methemoglobinemia; Nitrites; Quaternary Ammonium Compounds; Sodium Nitrite