Texas Tech University Health Sciences Center at EI Paso, Paul L. Foster School of Medicine, USA.
Curr Pharm Biotechnol. 2012 Aug;13(10):1940-8. doi: 10.2174/138920112802273182.
Cyanide poisoning can present in multiple ways, given its widespread industrial use, presence in combustion products, multiple physical forms, and chemical structures. The primary target of toxicity is mitochondrial cytochrome oxidase. The onset and severity of poisoning depend on the route, dose, physicochemical structure and other variables. Common poisoning features include dyspnea, altered respiratory patterns, abnormal vital signs, altered mental status, seizures, and lactic acidosis. Our present knowledge supports cyanide poisoning treatment based on excellent supportive care with adjunctive antidotal therapy. Multiple antidotes exist and vary in regional availability. All currently marketed antidotes appear to be effective. Antidotal mechanisms include chelation, formation of stable, less toxic complexes, methemoglobin induction, and sulfane sulfur supplementation for detoxification by endogenous rhodanese. Each antidote has advantages and disadvantages. For example, hydroxocobalamin is safer than the methemoglobin inducers in patients with smoke inhalation. Research for new, safer and more effective cyanide antidotes continues.
氰化物中毒的表现形式多种多样，这与其广泛的工业用途、燃烧产物中的存在、多种物理形态和化学结构有关。毒性的主要靶标是线粒体细胞色素氧化酶。中毒的发作和严重程度取决于途径、剂量、物理化学结构和其他变量。常见的中毒特征包括呼吸困难、呼吸模式改变、生命体征异常、意识状态改变、癫痫发作和乳酸性酸中毒。我们目前的知识支持基于良好的支持性治疗和辅助解毒治疗的氰化物中毒治疗。存在多种解毒剂，其在区域内的可获得性有所不同。目前所有市售的解毒剂似乎都有效。解毒机制包括螯合、形成稳定、毒性较低的复合物、诱导高铁血红蛋白和补充含硫磺酸以通过内源性硫代硝酸酯酶解毒。每种解毒剂都有其优点和缺点。例如，羟钴胺在吸入烟雾的患者中比高铁血红蛋白诱导剂更安全。新的、更安全和更有效的氰化物解毒剂的研究仍在继续。
