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Review article: management of cyanide poisoning


Reade, MC and Davies, SR and Morley, PT and Dennett, J and Jacobs, IC, Review article: management of cyanide poisoning, Emergency medicine Australasia, 24, (3) pp. 225-238. ISSN 1742-6731 (2012) [Refereed Article]

Copyright Statement

2012 The Authors EMA 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine

DOI: doi:10.1111/j.1742-6723.2012.01538.x


Cyanide poisoning is uncommon, but generates interest because of the presumed utility of an antidote immediately available in those areas with a high risk of cyanide exposure. As part of its regular review of guidelines, the Australian Resuscitation Council conducted a systematic review of the human evidence for the use of various proposed cyanide antidotes, and a narrative review of the relevant pharmacological and animal studies. There have been no relevant comparative or placebo-controlled human trials. Nine case series were identified. Treatment with hydroxocobalamin was reported in a total of 361 cases. No serious adverse effects of hydroxocobalamin were reported, and many patients with otherwise presumably fatal poisoning survived. Sodium thiosulphate use was reported in two case series, similarly with no adverse effects. Treatment with a combination of sodium nitrite, amyl nitrite and sodium thiosulphate was reported in 74 patients, with results indistinguishable from those of hydroxocobalamin and sodium thiosulphate. No case series using dicobalt edetate or 4-dimethylaminophenol were identified, but successful use in single cases has been reported. Hydroxocobalamin and sodium thiosulphate differ from alternatives in having negligible adverse effects, and on the basis of current evidence are the antidotes of choice. The indications for the use of an antidote, the requirements for supportive care and a recommended approach for workplaces where there is a risk of cyanide poisoning are presented.

Item Details

Item Type:Refereed Article
Keywords:cyanide, emergency medicine, poisoning
Research Division:Biomedical and Clinical Sciences
Research Group:Clinical sciences
Research Field:Paramedicine
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Davies, SR (Ms Suzanne Avis)
ID Code:134405
Year Published:2012
Web of Science® Times Cited:51
Deposited By:Paramedicine
Deposited On:2019-08-12
Last Modified:2019-09-13

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