Zakharov Sergey, Vaneckova Manuela, Seidl Zdenek, Diblik Pavel, Kuthan Pavel, Urban Pavel, Navratil Tomas, Pelclova Daniela
Department of Occupational Medicine, Toxicological Information Centre, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
Department of Radiodiagnostics, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
Basic Clin Pharmacol Toxicol. 2015 Sep;117(3):209-12. doi: 10.1111/bcpt.12387. Epub 2015 Feb 25.
Hydroxocobalamin is an effective first-line antidote used mainly in monotherapy of cyanide poisonings, while the opinions are different on the effects of its combination with sodium thiosulfate. A 58-year-old male committed a suicide attempt by ingesting of 1200-1500 mg of potassium cyanide; he was unconscious for 1-1.5 min. after ingestion with the episode of generalized seizures. On admission to the ICU, the patient was acidotic (pH 7.28; HCO3 14.0 mmol/L, base excess -12.7 mmol/L, saturation O2 0.999) with high serum lactate (12.5 mmol/L). Hydroxocobalamin was administered 1.5 hr after ingestion in two subsequent intravenous infusions at a total dose of 7.5 g. The infusion was followed by continuous intravenous administration of 1 mL/hr/kg of 10% sodium thiosulfate at a total dose of 12 g. No complications and adverse reactions were registered. Serum lactate decreased to 0.6 mmol/L the same day, and arterial blood gases became normal (pH 7.49; HCO3 27.2 mmol/L, base excess 2.2 mmol/L, saturation O2 0.994). The follow-up examination 5 months later revealed no damage of basal ganglia and cerebellum on magnetic resonance imaging. The neurological examination revealed no pathological findings. On the ocular coherence tomography, the retinal nerve fibres layer was normal. In visual evoked potentials, there was a normal evoked complex on the left eye and minor decrease in amplitude on the right eye. Combination of hydroxocobalamin and sodium thiosulfate can have a positive effect on the survival without long-term neurological and visual sequelae in the cases of massive cyanide poisonings due to the possibility of a potentiation or synergism of hydroxocobalamin effects by sodium thiosulfate. This synergism can be explained by the different time-points of action of two antidotes: the initial and immediate effect of hydroxocobalamin, followed by the delayed, but more persistent effect of sodium thiosulfate.
羟钴胺素是一种有效的一线解毒剂，主要用于氰化物中毒的单一疗法，但其与硫代硫酸钠联合使用的效果存在不同观点。一名58岁男性摄入1200 - 1500毫克氰化钾企图自杀；摄入后他昏迷了1 - 1.5分钟，并伴有全身性癫痫发作。入住重症监护病房时，患者酸中毒（pH 7.28；HCO3 14.0 mmol/L，碱剩余 -12.7 mmol/L，氧饱和度0.999），血清乳酸水平高（12.5 mmol/L）。摄入后1.5小时给予羟钴胺素，分两次静脉输注，总剂量为7.5克。输注后持续静脉输注10%硫代硫酸钠，剂量为1毫升/小时/千克，总剂量为12克。未记录到并发症和不良反应。当天血清乳酸降至0.6 mmol/L，动脉血气恢复正常（pH 7.49；HCO3 27.2 mmol/L，碱剩余2.2 mmol/L，氧饱和度0.994）。5个月后的随访检查显示，磁共振成像未发现基底神经节和小脑受损。神经学检查未发现病理结果。眼部相干断层扫描显示视网膜神经纤维层正常。视觉诱发电位检查发现，左眼诱发电位复合波正常，右眼振幅略有下降。由于硫代硫酸钠可能增强或协同羟钴胺素的作用，在大量氰化物中毒病例中，羟钴胺素与硫代硫酸钠联合使用对患者存活且无长期神经和视觉后遗症可能具有积极作用。这种协同作用可以通过两种解毒剂不同的作用时间点来解释：羟钴胺素的初始和即时作用，随后是硫代硫酸钠延迟但更持久的作用。
