Combined antidotal and hemodialysis treatments for nitroprusside-induced cyanide toxicity

A case report is presented for a patient with nitroprusside-induced cyanide intoxication. The patient received approximately 1 g sodium nitroprusside through an intravenous infusion of the drug over 6 d. The toxicity was treated with antidotes, sodium nitrite and sodium thiosulfate, followed by hemodialysis. Hemodialysis significantly removed thiocyanate but not cyanide from the patient's extracorporeal circulation. The removal of thiocyanate by hemodialysis enhanced the liberation of cyanide from the cytochrome oxidase. Hemodialysis is a significant addition to the therapy of cyanide toxicity, particularly for intoxicated patient with reduced renal function