![]() ![]() In that same study, hydroxocobalamin (total dose 5 to 20 g) was given as first-line antidotal therapy beginning a mean of 3.1 hours (3.2 standard deviation, median 2.1 hours, range 0.3 to 12) after cyanide exposure. Reported events included chromaturia (red urine n = 5), pink-to-red skin discoloration ( n = 3), increase in heart rate ( n = 1), and elevated blood pressure ( n = 1). In a small retrospective study of 14 cyanide-intoxicated human patients, adverse events that may have been caused by hydroxocobalamin were reported in 8 patients (57%). 20 It does not cause hypotension or methemoglobinemia and may therefore be reasonably given to victims before confirming cyanide exposure. ![]() It is believed that it takes at least 5 g of hydroxocobalamin administered intravenously over 10 minutes to neutralize a lethal dose of cyanide in adults. This may be especially important in cases of possible carbon monoxide intoxication. Because hydroxocobalamin does not interfere with oxygencarrying capacity of blood, it may be a superior therapy compared to nitrites. Survival was significantly improved compared with placebo. In cyanidepoisoned adult dogs, the use of Cyanokit resulted in reduced whole-blood cyanide concentration by approximately 55% by the end of treatment. ![]() Cyanokit (containing the drug hydroxocobalamin, intravenous tubing, and a sterile spike for reconstituting the drug product with saline) may be used in the United States and other countries for the treatment of known or suspected cyanide poisoning. Hydroxocobalamin was recently approved in the United States for use as a component of the Cyanokit. The simple mechanism of action is that hydroxocobalamin binds cyanide and forms nontoxic cyanocobalamin, which is excreted in urine. Hydroxocobalamin has been used for decades to treat acute cyanide poisoning in Europe and was approved for use in France in 1996. Dobbs, in Clinical Neurotoxicology, 2009 Hydroxocobalamin ![]()
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