The use of dicobalt edetate (Kelocyanor) in cyanide poisoning

Hillman, B.; Bardhan, K. D.; Bain, Jessica

doi:10.1136/pgmj.50.581.171

Cited by 40 publications

(6 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Serious adverse effects recorded from dicobalt edetate include vomiting, urticaria, anaphylactic shock, hypotension, and ventricular arrhythmias. [68][69][70] The need for a cyanide antidote with a better risk/ benefit ratio than the current option in the United States is increasingly recognized. 10,11,71 In an attempt to meet this need, the vitamin B 12 precursor hydroxocobalamin is being studied for possible introduction in the United States as a cyanide antidote.…”

Section: Cyanide Antidotesmentioning

confidence: 99%

Pediatric Cyanide Poisoning: Causes, Manifestations, Management, and Unmet Needs

Geller

Barthold

Saiers³

et al. 2006

Pediatrics

View full text Add to dashboard Cite

Confirmed cases of childhood exposure to cyanide are rare despite multiple potential sources including inhalation of fire smoke, ingestion of toxic household and workplace substances, and ingestion of cyanogenic foods. Because of its infrequent occurrence, medical professionals may have difficulty recognizing cyanide poisoning, confirming its presence, and treating it in pediatric patients. The sources and manifestations of acute cyanide poisoning seem to be qualitatively similar between children and adults, but children may be more vulnerable than adults to poisoning from some sources. The only currently available antidote in the United States (the cyanide antidote kit) has been used successfully in children but has particular risks associated with its use in pediatric patients. Because hemoglobin kinetics vary with age, methemoglobinemia associated with nitrite-based antidotes may be excessive at standard adult dosing in children. A cyanide antidote with a better risk/benefit ratio than the current agent available in the United States is desirable. The vitamin B12 precursor hydroxocobalamin, which has been used in Europe, may prove to be an attractive alternative to the cyanide antidote kit for pediatric patients. In this article we review the available data on the sources, manifestations, and treatment of acute cyanide poisoning in children and discuss unmet needs in the management of pediatric cyanide poisoning.

show abstract

Section: Cyanide Antidotesmentioning

confidence: 99%

Pediatric Cyanide Poisoning: Causes, Manifestations, Management, and Unmet Needs

Geller

Barthold

Saiers³

et al. 2006

Pediatrics

View full text Add to dashboard Cite

show abstract

“…Dicobalt edetate has been used in numerous human cases in which patients survived 4 . The utility of dicobalt edetate is limited by its serious adverse effects, which include vomiting, urticaria, anaphylactic shock, hypotension and ventricular arrhythmias 50,51 . These harmful effects might be more common and severe in the absence of cyanide 4 .…”

Section: Resultsmentioning

confidence: 99%

“…4 The utility of dicobalt edetate is limited by its serious adverse effects, which include vomiting, urticaria, anaphylactic shock, hypotension and ventricular arrhythmias. 50,51 These harmful effects might be more common and severe in the absence of cyanide. 4 There is evidence from animal experiments that glucose protects against cobalt toxicity, and it is recommended that this be simultaneously administered.…”

Section: Dicobalt Edetatementioning

confidence: 99%

Review article: Management of cyanide poisoning

Reade

Davies

Morley

et al. 2012

Emerg Medicine Australasia

View full text Add to dashboard Cite

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.

show abstract

“…Hydroxocobalamin has been shown to reduce mortality in rats, mice, and beagles and has the advantage of producing neither methemoglobinemia nor hypotension, as sodium nitrite does (Hall and Rumack, 1987;Borron et al, 2006). Dicobalt-EDTA (Kelocyanor) and 4-dimethylaminophenol hydrochloride (4-DMAP) are other chelators available in Europe, Israel, and Australia, but not in the United States (Hillman et al, 1974;Weger, 1990).…”

Section: Decontamination and Treatmentmentioning

confidence: 98%