Cyanide

Cyanide was originally discovery in the 18th century.  In the 20th century it became a means to commit suicide, murder and mass execution.  Cyanide is also a substance used in variety industries ranging from mining to electroplating and is a byproduct in oil refineries.  Exposures, both chronic and acute, do happen.  Thankfully there are antidotes available to treat cyanide poisoning.

Treatment initially starts with oxygen.  Refinery workers with low level cyanide exposure have done well with only oxygen as treatment.  The key is low level exposure.  Patient that are more symptomatic require more aggressive care.  For decades we have successfully used the Lily cyanide antidote kit as our source of life saving drugs.  Unfortunately the antidote kit, which consists of amyl nitrite, sodium nitrite and sodium thiosulfate, is no longer being manufactured.  Amyl nitrite can be purchased in bulk from a variety of distributors.  Sodium nitrite and sodium thiosulfate is available as an FDA approved combination product, Nithiodote, by Hope Pharmaceuticals.  There is a different antidote, hydroxocobalamine (Cyanokit) that is also available.  It is easier to use, works quickly and has a good adverse effect profile.  It can also be used in patients suffering from smoke inhalation.  Hydroxocobalamine has a long history of successful use in Europe.  Its downfall - cost.  Many hospitals simple do not carry it.

As health care providers and pharmacists it is incumbent on us to insure that we have the right tools to treat patients is the best way possible.  As the old kits expire hopefully hospitals will appropriately start stocking hydroxocobalamine.