Friday, October 15, 2004

Global attitude and the popular treatment

A retrospective examination of various cyanide antidotes reveals that there is no unanimity of opinion regarding the efficacy of a particular treatment regiment. The recommended agents or components of specific antidotal therapies for cyanide poisoning vary according to country and medical custom. This diversity seems to be based, in part, on where the drugs were initially developed, used and due to different experimental conditions, test protocols and species of animals employed in evaluating various antidotes3,4. The aims of the recommended therapies are generally similar, however, in that one drug is given for immediate relief from histotoxic effect of cyanide complexed with cytochrome oxidase3,4,7. There is no global unanimity on this issue, like SN and STS combination is the drug of choice for cyanide poisoning in U.S.A. and many other countries, France and U.K. have adopted kelocyanor while Germany is still continuing with DMAP and STS combination. However, SN (10 ml of 3 % solution) and STS (50 ml 25% solution) combination is still the most prevalent treatment in cyanide poisoning. Artificial ventilation with 100 % oxygen via ambu bag containing the contents of two ampoules of amylnitrite (0.6 ml) is usually practiced as the first aid therapy. The use of antidote should be restricted to patients in deep coma with respiratory insufficiency. Supportive therapy of diazepam i.v.(3 x 10 mg) and 4.2% sodium bicarbonate solution to correct the convulsions and metabolic acidosis respectively have also been used in human poisoning. To revert excessive methaemoglobulinemia i.v. administration of 30 ml of 1 % methylene blue solution is also recommended.

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