Subject: Re: Cyanide Poisoning
Yeeees
If the patient has got to hospital it is unlikely to be cyanide poisoning
>>>
Yes perhaps if inhalation of HCN, often no if poisoning due to ingestion of
cyanide salts/compounds giving rise to cyanide by metabolism.
Dilemma (recent case in UK with unfortunate outcome) is clinicians
increasingly reluctant to give dicobalt EDTA even when all the
clinical/circumstantial evidence points to cyanide poisoning as risk of
toxicity if given to someone not poisoned with cyanide. Possible answer is
to give hydroxocobalamin (as well as the other cyanide antidotes) as safe in
the absence of cyanide, but large doses (of expensive drug) needed quickly
and cyanide poisoning rare, hence logistics come into it - there is not
really the time to move hydroxocobalamin from central locations as with some
other rarely needed antidotes. Similarly as Bob Forrest pointed out
treatment must be a clinical decision as not time for lab confirmation with
current methods (for a rare test).
Hope this helpful. More info on cyanide poisoning on Toxbase.
Bob Flanagan
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