Cyanide antidotes and fire toxicology

Article Abstract:

A myriad of complex chemical reactions occur in the heat of a fire, and the chemical composition of smoke is equally complex. Smoke consists of carbon particles coated with various substances and heated gases, including both irritants and poisons. Smoke often contains considerable amounts of hydrogen cyanide, but until recently there has been little agreement on the degree to which cyanide contributes to death from smoke inhalation. One of the major problems with assessing the dangers of cyanide is that it rapidly disappears from the blood; analysis performed more than an hour or so after the victim inhaled the smoke will not faithfully represent the actual cyanide exposure. In the December 19, 1991 issue of The New England Journal of Medicine, researchers report the results of a study in which blood specimens were obtained at the scene of fires as the victims of smoke inhalation were receiving their first medical attention. It was confirmed that cyanide levels were far greater in the blood of the smoke inhalation victims who died than in the blood of the victims who survived. Possible cyanide poisoning demands rapid attention and it is not possible to wait for sophisticated blood tests. The approved antidotes for cyanide poisoning are nitrites and thiosulfates. Nitrites, such as sodium nitrite and amyl nitrite, apparently work by converting hemoglobin in the blood to methemoglobin, which actively binds cyanide, preventing it from entering cells. However, these substances may cause a drop in blood pressure, which may have a disastrous effect on the patient. Thiosulfate can be used by the body's enzymes to convert cyanide into the less poisonous thiocyanate, which is then excreted in the urine. However, the best hope for cyanide poisoning is the orphan drug hydroxocobalamin. This drug binds and inactivates cyanide, but does not alter normal hemoglobin. Hydroxocobalamin is apparently safer than sodium nitrite. If current tests result in the approval of hydroxocobalamin for the treatment of cyanide poisoning, treatment decisions for victims of smoke inhalation may be made considerably easier. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Editorial

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Elevated blood cyanide concentrations in victims of smoke inhalation

Article Abstract:

Many people who die in fires are not burned to death, but die from the toxic effects of smoke inhalation. However, it is not certain what components of smoke contribute most to these fatal effects. The smoke is known to contain carbon monoxide, but the products of combustion of many common materials contain a multitude of other substances as well, including hydrogen cyanide. Hydrogen cyanide may be released by burning a variety of substances, including many plastics and synthetic fibers, as well as natural substances such as wool and silk. However, it is difficult to determine whether hydrogen cyanide is actually responsible for many of the fatalities which result from smoke inhalation. Traces of cyanide disappear from the blood within a few hours of death. As a result, no conclusive findings have confirmed a correlation between hydrogen cyanide in the blood and the risk of death. In an attempt to clarify the role of hydrogen cyanide gas in smoke inhalation deaths, cyanide, as well as carbon monoxide and indicators of metabolism, was measured in the blood of victims while still at the scene of the fire. The 43 fire victims who died had significantly higher amounts of cyanide in their blood than did the 66 fire victims who survived. It was found that there was a good correlation between hydrogen cyanide concentrations and concentrations of carbon monoxide in the blood. However, the cyanide concentration was found to correlate more strongly with the concentration of lactate in the blood plasma. This was the result of the accumulation of lactate that occurred as the normal cellular respiration was inhibited by cyanide. The plasma concentration of lactate may therefore prove useful in estimating cyanide toxicity in fire victims admitted to the hospital. The results of this study implicate hydrogen cyanide as an important contributor to deaths from smoke inhalation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Fires

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Brief report: treatment of severe colchicine overdose with colchicine-specific Fab fragments

Article Abstract:

A 25-year-old woman was completely cured of severe colchicine poisoning by treatment with colchicine-specific Fab fragments. Colchicine is used to treat gout, but she had taken 60 tablets in a suicide attempt. She was admitted to a hospital, where she experienced circulatory collapse, shock and fluid accumulation in her lungs. She was treated with a six-hour intravenous infusion of colchicine-specific Fab fragments, which are portions of the antibody that binds to colchicine. Within 30 minutes, her blood pressure rose and her circulatory system stabilized. Her kidneys, which had shut down, began producing urine. Blood levels of colchicine bound to the Fab fragment increased, indicating that the fragment was pulling the drug out of her tissues and into her blood, where it was excreted in her urine. Without treatment with Fab fragments, it is likely she would have died.

Antigen-antibody reactions, Colchicine

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