miscellaneous

Question 1

treatment of cyanide toxicity

Answer 1

-supportive care: airway control, ventilation, 100% oxygen delivery, crystalloids and vasopressors as needed for hypotension
-Activated charcoal should be given after oral exposure in alert patients who are able to protect their airway or after endotracheal intubation in unconscious patients
-Hydroxocobalamin combines with cyanide to form cyanocobalamin (vitamin B12), which is renally excreted
-Co-administration of sodium thiosulfate has been suggested to have a synergic effect on detoxification
-Sodium nitrite induces methaemoglobin in red blood cells, which combines with cyanide, thus releasing cytochrome oxidase enzyme.
-Sodium thiosulfate enhances the conversion of cyanide to thiocyanate, which is renally excreted
-Thiosulfate has a delayed effect and is typically used with sodium nitrite for faster antidote action.