Abstract | STUDY OBJECTIVE: METHODS: Twenty-four swine were intubated, anesthetized, and instrumented (continuous arterial and cardiac output monitoring) and then intoxicated with a continuous cyanide infusion until severe hypotension. The animals were divided into 2 arms of 12 each and then randomly assigned to intravenous hydroxocobalamin (150 mg/kg)+ sodium thiosulfate (413 mg/kg) or sodium nitrite (10 mg/kg)+ sodium thiosulfate (413 mg/kg) and monitored for 40 minutes after start of antidotal infusion. Twenty animals were needed for 80% power to detect a significant difference in outcomes (alpha 0.05). Repeated measures of analysis of covariance and post hoc t test were used for determining significance. RESULTS: Baseline mean weights, time to hypotension (31 minutes 3 seconds versus 28 minutes 6 seconds), and cyanide dose at hypotension (5.6 versus 5.9 mg/kg) were similar. One animal in the hydroxocobalamin group and 2 animals in the sodium nitrite group died during antidote infusion and were excluded from analysis. Hydroxocobalamin resulted in a faster return to baseline mean arterial pressure, with improvement beginning at 5 minutes and lasting through the conclusion of the study (P<.05). No statistically significant difference was detected between groups for cardiac output, pulse rate, systemic vascular resistance, or mortality at 40 minutes post intoxication. Mean cyanide blood levels (4.03 versus 4.05 microg/mL) and lactate levels (peak 7.9 versus 8.1 mmol/L) at hypotension were similar. Lactate levels (5.1 versus 4.48 mmol/L), pH (7.40 versus 7.37), and base excess (-0.75 versus 1.27) at 40 minutes were also similar. CONCLUSION:
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Authors | Vikhyat S Bebarta, David A Tanen, Julio Lairet, Patricia S Dixon, Sandra Valtier, Anneke Bush |
Journal | Annals of emergency medicine
(Ann Emerg Med)
Vol. 55
Issue 4
Pg. 345-51
(Apr 2010)
ISSN: 1097-6760 [Electronic] United States |
PMID | 19944487
(Publication Type: Comparative Study, Journal Article, Research Support, U.S. Gov't, Non-P.H.S.)
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Copyright | Copyright (c) 2009 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved. |
Chemical References |
- Antidotes
- Cyanides
- Lactates
- Thiosulfates
- sodium thiosulfate
- Sodium Nitrite
- Hydroxocobalamin
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Topics |
- Acidosis
(chemically induced, drug therapy)
- Animals
- Antidotes
(administration & dosage, therapeutic use)
- Blood Pressure
(drug effects)
- Cyanides
(poisoning)
- Disease Models, Animal
- Drug Therapy, Combination
- Female
- Hydroxocobalamin
(therapeutic use)
- Hypotension
(chemically induced, drug therapy)
- Lactates
(blood)
- Male
- Monitoring, Physiologic
- Sodium Nitrite
(therapeutic use)
- Sus scrofa
- Thiosulfates
(therapeutic use)
- Time Factors
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