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http://dx.doi.org/10.3345/kjp.2010.53.8.805

Successful treatment by exchange transfusion of a young infant with sodium nitroprusside poisoning  

Baek, Jong-Geun (Department of Pediatrics, Gyeongsang National University School of Medicine)
Jeong, Hoar-Lim (Department of Pediatrics, Gyeongsang National University School of Medicine)
Park, Ji-Sook (Department of Pediatrics, Gyeongsang National University School of Medicine)
Seo, Ji-Hyun (Department of Pediatrics, Gyeongsang National University School of Medicine)
Park, Eun-Sil (Department of Pediatrics, Gyeongsang National University School of Medicine)
Lim, Jae-Young (Department of Pediatrics, Gyeongsang National University School of Medicine)
Park, Chan-Hoo (Department of Pediatrics, Gyeongsang National University School of Medicine)
Woo, Hyang-Ok (Department of Pediatrics, Gyeongsang National University School of Medicine)
Youn, Hee-Shang (Department of Pediatrics, Gyeongsang National University School of Medicine)
Yeom, Jung-Sook (Department of Pediatrics, Gyeongsang National University School of Medicine)
Publication Information
Clinical and Experimental Pediatrics / v.53, no.8, 2010 , pp. 805-808 More about this Journal
Abstract
Although sodium nitroprusside (SNP) is often used in pediatric intensive care units, cyanide toxicity can occur after SNP treatment. To treat SNP-induced cyanide poisoning, antidotes such as amyl nitrite, sodium nitrite, sodium thiosulfate, and hydroxycobalamin should be administered immediately after diagnosis. Here, we report the first case of a very young infant whose SNP-induced cyanide poisoning was successfully treated by exchange transfusion. The success of this alternative method may be related to the fact that exchange transfusion not only removes the cyanide from the blood but also activates detoxification systems by supplying sulfur-rich plasma. Moreover, exchange transfusion replaces cyanide-contaminated erythrocytes with fresh erythrocytes, thereby improving the blood's oxygen carrying capacity more rapidly than antidote therapy. Therefore, we believe that exchange transfusion might be an effective therapeutic modality for critical cases of cyanide poisoning.
Keywords
Nitroprusside; Exchange transfusion; Cyanides; Poisoning; Detoxification; Infant;
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1 Sancak R, Kucukoduk S, Tasdemir HA, Belet N. Exchange transfusion treatment in a newborn with phenobarbital intoxication. Pediatr Emerg Care 1999;15:268-70.   DOI
2 Tauberger G, Karzel K, Roezel V. The efficacy of blood exchange transfusions in the treatment of acute cyanide poisoning (author's transl). Arch Toxicol 1974;32:189-97.   DOI   ScienceOn
3 Stoll BJ. Anemia in the newborn infant. In: Kliegman RM, Jenson HB, Behrman RE, Stanton BF, editors. Nelson textbook of pediatrics. 18th ed. Philadelphia: Saunders Co, 2007:771-2.
4 Fasco MJ, Iii CR, Stack RF, O'hehir C, Barr JR, Eadon GA. Cyanide adducts with human plasma proteins: Albumin as a potential exposure surrogate. Chem Res Toxicol 2007;20:677-84.   DOI   ScienceOn
5 Manikian A, Stone S, Hamilton R, Foltin G, Howland MA, Hoffman RS. Exchange transfusion in severe infant salicylism. Vet Hum Toxicol 2002;44:224-7.
6 Shannon M, Wernovsky G, Morris C. Exchange transfusion in the treatment of severe theophylline poisoning. Pediatrics 1992;89:145-7.
7 Kulig K. Cyanide antidotes and fire toxicology. N Engl J Med 1991;325:1801-2.   DOI   ScienceOn
8 Thomas C, Svehla L, Moffett BS. Sodium-nitroprusside-induced cyanide toxicity in pediatric patients. Expert Opin Drug Saf 2009;8:599-602.   DOI   ScienceOn
9 Przybylo HJ, Stevenson GW, Schanbacher P, Backer C, Dsida RM, Hall SC. Sodium nitroprusside metabolism in children during hypothermic cardiopulmonary bypass. Anesth Analg 1995;81:952-6.
10 Schulz V, Bonn R, Kindler J. Kinetics of elimination of thiocyanate in 7 healthy subjects and in 8 subjects with renal failure. Klin Wochenschr 1979;57:243-7.   DOI
11 Baud FJ, Barriot P, Toffis V, Riou B, Vicaut E, Lecarpentier Y, et al. Elevated blood cyanide concentrations in victims of smoke inhalation. N Engl J Med 1991;325:1761-6.   DOI   ScienceOn
12 Geller RJ, Barthold C, Saiers JA, Hall AH. Pediatric cyanide poisoning: Causes, manifestations, management, and unmet needs. Pediatrics 2006;118:2146-58.   DOI   ScienceOn
13 Way JL. Cyanide intoxication and its mechanism of antagonism. Annu Rev Pharmacol Toxicol 1984;24:451-81.   DOI   ScienceOn
14 Benitz WE, Malachowski N, Cohen RS, Stevenson DK, Ariagno RL, Sunshine P. Use of sodium nitroprusside in neonates: Efficacy and safety. J Pediatr 1985;106:102-10.   DOI
15 Linakis JG, Lacouture PG, Woolf A. Monitoring cyanide and thiocyanate concentrations during infusion of sodium nitroprusside in children. Pediatr Cardiol 1991;12:214-8.   DOI   ScienceOn
16 Schulz V. Clinical pharmacokinetics of nitroprusside, cyanide, thiosulphate and thiocyanate. Clin Pharmacokinet 1984;9:239-51.   DOI   ScienceOn
17 Friederich JA, Butterworth JF 4th. Sodium nitroprusside: twenty years and counting. Anesth Analg 1995;81:152-62.
18 Moffett BS and Price JF. Evaluation of sodium nitroprusside toxicity in pediatric cardiac surgical patients. Ann Pharmacother 2008;42:1600-4.   DOI   ScienceOn
19 Gilboa N and Urizar RE. Severe hypertension in newborn after pyeloplasty of hydronephrotic kidney. Urology 1983;22:179-82.   DOI   ScienceOn