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Treatment of acute cyanide intoxication with hemodialysis
Insights
Hemodialysis effectively treats cyanide poisoning by removing cyanide and its toxic metabolite, thiocyanate. This study quantizes hemodialysis clearance for cyanide, showing its benefit as a life-saving therapy.
Area of Science:
- Toxicology
- Nephrology
- Emergency Medicine
Background:
- Cyanide poisoning is a life-threatening condition requiring prompt treatment.
- Limited data exists on hemodialysis efficacy for cyanide intoxication.
- Hemodialysis was observed to dramatically improve a patient with severe acidosis from cyanide.
Observation:
- Hemodialysis clearance and extraction ratio of cyanide were investigated in a canine model.
- Dogs received constant infusions of cyanide, with and without thiosulfate co-administration.
- The study quantified hemodialysis effectiveness in cyanide poisoning management.
Findings:
- Hemodialysis clearance of cyanide with thiosulfate was 38.3 mL/min (extraction ratio 0.43).
- Hemodialysis increased the lethal dose of cyanide, with greater effect when thiosulfate was co-administered.
- Thiosulfate facilitates cyanide metabolism to thiocyanate, which is efficiently cleared by hemodialysis.
Implications:
- Hemodialysis is an effective adjunct therapy for acute cyanide intoxication.
- The removal of both cyanide and its metabolite thiocyanate contributes to treatment efficacy.
- Findings support the use of hemodialysis in managing severe cyanide poisoning cases.
Abstract:
A dramatic response was noted in a patient at our hospital who received hemodialysis therapy for severe acidosis secondary to an unknown toxin, subsequently identified as cyanide. We were unable to find any information concerning the hemodialysis clearance and extraction ratio of cyanide; thus, we studied the effect of hemodialysis in dogs receiving a constant infusion of cyanide with and without a simultaneous infusion of thiosulfate. The hemodialysis clearance of cyanide in the presence of thiosulfate was 38.3 +/- 5.4 ml/min with an extraction ratio of 0.43 +/- 0.06 (n = 4). Hemodialysis was found to increase the lethal dose of cyanide without thiosulfate infusion, and a further increase was noted with the thiosulfate infusion. Thiosulfate promotes mitochondrial metabolism of cyanide to thiocyanate. The end product, thiocyanate, is quickly removed by hemodialysis. We believe that the demonstrated effectiveness of hemodialysis in the treatment of acute cyanide intoxication is related not only to the hemodialysis clearance of cyanide, but also to the removal of its metabolic end product, thiocyanate. Based on our observations, we feel that hemodialysis is an effective adjunct in the treatment of acute cyanide intoxication.