Cyanide poisoning and its treatment
Abstract
Cyanide is both widely available and easily accessible throughout the world. Although the compound is not frequently encountered, it has been used as a poison and contaminant in the past and is a potential terrorist agent. Cyanide has the ability to cause significant social disruption and demands special attention to public health preparedness. It can be obtained from a variety of sources, including industrial, medical, and even common household products. Another frequently encountered source of cyanide exposure is residential fires. Exposure to high concentrations of the chemical can result in death within seconds to minutes. Long-term effects from cyanide exposure can cause significant morbidity. The only treatment for cyanide toxicity approved for use in the United States is a kit consisting of amyl nitrite, sodium nitrite, and sodium thiosulfate. Future research aims to find a faster-acting, more effective, and better tolerated treatment for cyanide toxicity.
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Therapeutic administration of sodium nitrite 30 mg/ml over 5-20 minutes (~300 mg total) significantly increases metHb levels (~20%) that can bind with cyanide to form cyanmethemoglobin thus competing with cytochrome oxidase a3.
“Therapeutic administration of sodium nitrite 30 mg/ml over 5–20 minutes (~300 mg total) significantly increases metHb (i.e. ferric heme) levels (~20%) that can bind with cyanide to form cyanmethemoglobin thus competing with cytochrome oxidase a3 [134].”
From Inorganic nitrite therapy: historical perspective and future directions (2011) · cites this paper as [134]
The beneficial effect of sodium nitrite stems from the fact that cyanide has a high binding affinity for ferric iron, which is the basis of cyanide inhibition of cytochrome oxidase a3 thus decreasing mitochondrial respiration.
“The beneficial effect of sodium nitrite stems from the fact that cyanide has a high binding affinity for ferric iron, which is the basis of cyanide inhibition of cytochrome oxidase a3 thus decreasing mitochondrial respiration [133].”
From Inorganic nitrite therapy: historical perspective and future directions (2011) · cites this paper as [133]
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References 94 · Cited by 173
- Authors
- Gracia, R., & Shepherd, G.
- Affiliations
- University of Georgia (US)
- Corresponding author
- Gracia, Rebeca
- ORCID
- Shepherd, Greene
- Venue
- Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy
- Publisher
- Wiley
- Published
- 2004-10
- Volume
- 24
- Issue
- 10
- Pages
- 1358-1365
- ISSN
- 0277-0008 (ISSN-L)
- 1875-9114
- OpenAlex
- W2017801064
- Cited by
- 173
- References
- 94
- Citations by year
- 2026: 11 · 2025: 12 · 2024: 11 · 2023: 7 · 2022: 8 · 2021: 8 · 2020: 4 · 2019: 10 · 2018: 9 · 2017: 7 · 2016: 7 · 2015: 11 · 2014: 3 · 2013: 9 · 2012: 9
- FWCI
- 1.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Emergency Medicine › Poisoning and overdose treatments
- Life Sciences › Agricultural and Biological Sciences › Plant Science › Cassava research and cyanide
- Health Sciences › Medicine › Pathology and Forensic Medicine › Historical and Scientific Studies
- Keywords
- cyanide poisoning, amyl nitrite, sodium nitrite, sodium thiosulfate, public health preparedness, house fires
- MeSH terms
- Antidotes, Charcoal, Cyanides, Gastric Lavage, Humans, Poisoning
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