![]() Prospective study of hydroxocobalamin for acute cyanide. Because it binds with cyanide without forming methemoglobin, hydroxocobalamin can be used to treat patients without compromising the oxygen-carrying capacity of hemoglobin. 25 References Hydroxocobalamin for severe acute cyanide poisoning by ingestion or inhalation. Hydroxocobalamin detoxifies cyanide by binding with it to form the renally excreted, non-toxic cyanocobalamin. The key treatment is early administration of 1 of the 2 antidotes currently available in the United States: the well-known cyanide antidote kit and hydroxocobalamin. As poisoning progresses, hemodynamic status may become unstable. (Berlin, 1970 Douze and van Heijst, 1973). Early respiratory signs include transient rapid and deep respirations. Toxic effects appear at 40 methaemoglobinaemia and such toxicity has occurred in the treatment of cyanide poisoning. Skin may look normal or slightly ashen, and arterial oxygen saturation may be normal. As hypoxia progresses, progressively lower levels of consciousness, seizures, and coma can occur. Early manifestations include anxiety, headache, giddiness, inability to focus the eyes, and mydriasis. Signs and symptoms of cyanide poisoning usually occur less than 1 minute after inhalation and within a few minutes after ingestion. Cyanide causes intracellular hypoxia by reversibly binding to mitochondrial cytochrome oxidase a 3. In the United States, there are two antidote regimens (eTable 401) Hydroxocobalamin.
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