Detoxification of cyanide in a new-born child

Abstract

A well-developed male baby was given infusions of 2-5 microgram/kg/min of sodium nitroprusside (SNP) in the first few days after birth on account of high arterial blood pressure. After 30 h of treatment, cyanide accumulation was found to have reached a life-threatening level. IV administration of 100 mg/kg of sodium thiosulphate promptly lowered the cyanide level. The mixed infusion of SNP together with thiosulphate, used in the subsequent course, was no longer toxic.

Monitoring cyanide and thiocyanate concentrations during infusion of sodium nitroprusside in children

“…Administration of exogenous thiosulfate has been shown to protect against nitroprusside-related cyanide toxicity both in animals [11,18] and in humans [16]. Hydroxocobalamin has also been shown to prevent nitroprusside-induced cyanide toxicity, presumably by combining with free cyanide to form cyanocobalamin (vitamin B~z), which is excreted in the urine [3].…”

“…In addition, since the conversion of cyanide to thiocyanate is limited by the quantity of sulfur-containing substrates in the body (especially thiosulfate), the amount of substrate available will also influence the amount of time until accumulation of toxic amounts of cyanide. The rate of detoxification of cyanide has been demonstrated to be approximately 1 /~g/kg/min in a neonate [16], and several investigators have demonstrated accumulation of cyanide in the body when doses greater than 2 ~g/kg/min are given [1,8]. The children with toxic cyanide concentrations in our study had a mean infusion rate of 1.3 ~g/kg/min, although in contrast to the studies cited above, the duration of infusion was considerably longer (mean duration, 118 h versus <2 h).…”

Drug Treatment of Hypertensive Crisis in Children

“…[22] The administration of intravenous sodium thiosulfate has been reported to reduce elevated serum cyanide concentrations caused by sodium nitroprusside infusions due to its ability to replenish plasma thiosulfate levels. [23][24][25] Some institutions have prophylactically added sodium thiosulfate to all sodium nitroprusside infusions to decrease the potential for cyanide toxicity. This strategy, however, may not be a 'magic bullet' approach.…”

Sodium nitroprusside-associated cyanide toxicity in adult patients &ndash; fact or fiction? A critical review of the evidence and clinical relevance

“…25 evidence for CN toxicity associated with SNP Tables 1 and 2 are a summary of all published cases that have been reported in the literature regarding either mortality or morbidity associated with CN toxicity related to SNP administration. [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] Several things can be gleaned from these reports. Of the 4 cases related to intraoperative use, gross overdosing (.10 µg/kg/min) of SNP led to CN toxicity and death in 2 cases.…”