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Oral Glycine and Sodium Thiosulfate for Lethal Cyanide Ingestion

OBJECTIVE: Accidental or intentional cyanide ingestion is an-ever present danger. Rapidly acting, safe, inexpensive oral cyanide antidotes are needed that can neutralize large gastrointestinal cyanide reservoirs. Since humans cannot be exposed to cyanide experimentally, we studied oral cyanide poiso...

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Autores principales: Brenner, Matthew, Azer, Sarah M, Oh, Kyung-Jin, Han, Chang Hoon, Lee, Jangwoen, Mahon, Sari B, Du, Xiaohua, Mukai, David, Burney, Tanya, Saidian, Mayer, Chan, Adriano, Straker, Derek I, Bebarta, Vikhyat S, Boss, Gerry R
Formato: Online Artículo Texto
Lenguaje:English
Publicado: 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5578424/
https://www.ncbi.nlm.nih.gov/pubmed/28868209
http://dx.doi.org/10.4172/2167-7972.1000355
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author Brenner, Matthew
Azer, Sarah M
Oh, Kyung-Jin
Han, Chang Hoon
Lee, Jangwoen
Mahon, Sari B
Du, Xiaohua
Mukai, David
Burney, Tanya
Saidian, Mayer
Chan, Adriano
Straker, Derek I
Bebarta, Vikhyat S
Boss, Gerry R
author_facet Brenner, Matthew
Azer, Sarah M
Oh, Kyung-Jin
Han, Chang Hoon
Lee, Jangwoen
Mahon, Sari B
Du, Xiaohua
Mukai, David
Burney, Tanya
Saidian, Mayer
Chan, Adriano
Straker, Derek I
Bebarta, Vikhyat S
Boss, Gerry R
author_sort Brenner, Matthew
collection PubMed
description OBJECTIVE: Accidental or intentional cyanide ingestion is an-ever present danger. Rapidly acting, safe, inexpensive oral cyanide antidotes are needed that can neutralize large gastrointestinal cyanide reservoirs. Since humans cannot be exposed to cyanide experimentally, we studied oral cyanide poisoning in rabbits, testing oral sodium thiosulfate with and without gastric alkalization. SETTING: University research laboratory. SUBJECTS: New Zealand white rabbits. INTERVENTIONS: Seven animal groups studied; Groups 1–5 received high dose oral NaCN (50 mg, >LD100) and were treated immediately with oral (via nasogastric tube): 1) saline, 2) glycine, 3) sodium thiosulfate or 4) sodium thiosulfate and glycine, or 5) after 2 min with intramuscular injection of sodium nitrite and sodium thiosulfate plus oral sodium thiosulfate and glycine. Groups 6–7 received moderate dose oral NaCN (25 mg, LD70) and delayed intramuscular 6) saline or 7) sodium nitrite-sodium thiosulfate. MEASUREMENTS AND MAIN RESULTS: All animals in the high dose NaCN group receiving oral saline or glycine died very rapidly, with a trend towards delayed death in glycine-treated animals; saline versus glycine-treated animals died at 10.3+3.9 and 14.6+5.9 min, respectively (p=0.13). In contrast, all sodium thiosulfate-treated high dose cyanide animals survived (p<0.01), with more rapid recovery in animals receiving both thiosulfate and glycine, compared to thiosulfate alone (p<0.03). Delayed intramuscular treatment alone in the moderate cyanide dose animals increased survival over control animals from 30% to 71%. Delayed treatment in high dose cyanide animals was not as effective as immediate treatment, but did increase survival time and rescued 29% of animals (p<0.01 versus cyanide alone). CONCLUSIONS: Oral sodium thiosulfate with gastric alkalization rescued animals from lethal doses of ingested cyanide. The combination of oral glycine and sodium thiosulfate may have potential for treating high dose acute cyanide ingestion and merits further investigation. The combination of systemic and oral therapy may provide further options.
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spelling pubmed-55784242017-08-31 Oral Glycine and Sodium Thiosulfate for Lethal Cyanide Ingestion Brenner, Matthew Azer, Sarah M Oh, Kyung-Jin Han, Chang Hoon Lee, Jangwoen Mahon, Sari B Du, Xiaohua Mukai, David Burney, Tanya Saidian, Mayer Chan, Adriano Straker, Derek I Bebarta, Vikhyat S Boss, Gerry R J Clin Toxicol Article OBJECTIVE: Accidental or intentional cyanide ingestion is an-ever present danger. Rapidly acting, safe, inexpensive oral cyanide antidotes are needed that can neutralize large gastrointestinal cyanide reservoirs. Since humans cannot be exposed to cyanide experimentally, we studied oral cyanide poisoning in rabbits, testing oral sodium thiosulfate with and without gastric alkalization. SETTING: University research laboratory. SUBJECTS: New Zealand white rabbits. INTERVENTIONS: Seven animal groups studied; Groups 1–5 received high dose oral NaCN (50 mg, >LD100) and were treated immediately with oral (via nasogastric tube): 1) saline, 2) glycine, 3) sodium thiosulfate or 4) sodium thiosulfate and glycine, or 5) after 2 min with intramuscular injection of sodium nitrite and sodium thiosulfate plus oral sodium thiosulfate and glycine. Groups 6–7 received moderate dose oral NaCN (25 mg, LD70) and delayed intramuscular 6) saline or 7) sodium nitrite-sodium thiosulfate. MEASUREMENTS AND MAIN RESULTS: All animals in the high dose NaCN group receiving oral saline or glycine died very rapidly, with a trend towards delayed death in glycine-treated animals; saline versus glycine-treated animals died at 10.3+3.9 and 14.6+5.9 min, respectively (p=0.13). In contrast, all sodium thiosulfate-treated high dose cyanide animals survived (p<0.01), with more rapid recovery in animals receiving both thiosulfate and glycine, compared to thiosulfate alone (p<0.03). Delayed intramuscular treatment alone in the moderate cyanide dose animals increased survival over control animals from 30% to 71%. Delayed treatment in high dose cyanide animals was not as effective as immediate treatment, but did increase survival time and rescued 29% of animals (p<0.01 versus cyanide alone). CONCLUSIONS: Oral sodium thiosulfate with gastric alkalization rescued animals from lethal doses of ingested cyanide. The combination of oral glycine and sodium thiosulfate may have potential for treating high dose acute cyanide ingestion and merits further investigation. The combination of systemic and oral therapy may provide further options. 2017-06-27 2017-06 /pmc/articles/PMC5578424/ /pubmed/28868209 http://dx.doi.org/10.4172/2167-7972.1000355 Text en http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Article
Brenner, Matthew
Azer, Sarah M
Oh, Kyung-Jin
Han, Chang Hoon
Lee, Jangwoen
Mahon, Sari B
Du, Xiaohua
Mukai, David
Burney, Tanya
Saidian, Mayer
Chan, Adriano
Straker, Derek I
Bebarta, Vikhyat S
Boss, Gerry R
Oral Glycine and Sodium Thiosulfate for Lethal Cyanide Ingestion
title Oral Glycine and Sodium Thiosulfate for Lethal Cyanide Ingestion
title_full Oral Glycine and Sodium Thiosulfate for Lethal Cyanide Ingestion
title_fullStr Oral Glycine and Sodium Thiosulfate for Lethal Cyanide Ingestion
title_full_unstemmed Oral Glycine and Sodium Thiosulfate for Lethal Cyanide Ingestion
title_short Oral Glycine and Sodium Thiosulfate for Lethal Cyanide Ingestion
title_sort oral glycine and sodium thiosulfate for lethal cyanide ingestion
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5578424/
https://www.ncbi.nlm.nih.gov/pubmed/28868209
http://dx.doi.org/10.4172/2167-7972.1000355
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