Janese David R, Donald Michael, McGee Emily, Bowers Jacquelyn
Emergency Medicine/Family Medicine, Louisiana State University Health Shreveport (LSUHS), Shreveport, USA.
Pharmacology, Louisiana State University Health Shreveport (LSUHS), Shreveport, USA.
Cureus. 2025 May 5;17(5):e83500. doi: 10.7759/cureus.83500. eCollection 2025 May.
Hydroxocobalamin (Cyanokit® (HealthTech BioActives, Spain)) is the first-line antidote for suspected cyanide toxicity, typically infused intravenously over 10-15 minutes. However, in critically unstable patients, faster delivery may be essential. This case describes a seven-year-old female patient found pulseless after exposure to heavy smoke in a residential fire. Following return of spontaneous circulation (ROSC) in the emergency department, the patient remained severely acidotic and hypoxic despite confirmation of a secure airway and initiation of mechanical ventilation. A 5 g dose of hydroxocobalamin was administered as a rapid push over two minutes. The intervention was well tolerated and associated with a significant 13.8% decrease in carboxyhemoglobin levels within 20 minutes, alongside progressive improvement in metabolic parameters. Although the patient ultimately suffered irreversible hypoxic-ischemic brain injury, this case highlights the potential utility of push-dose hydroxocobalamin in time-critical resuscitation scenarios involving suspected cyanide toxicity.
羟钴胺（Cyanokit®，西班牙HealthTech BioActives公司生产）是疑似氰化物中毒的一线解毒剂，通常在10 - 15分钟内静脉输注。然而，对于病情极度不稳定的患者，更快给药可能至关重要。本病例描述了一名7岁女性患者，在住宅火灾中吸入浓烟后被发现心跳骤停。在急诊科恢复自主循环（ROSC）后，尽管已确认气道安全并开始机械通气，但患者仍严重酸中毒和缺氧。给予5克剂量的羟钴胺，在两分钟内快速推注。该干预耐受性良好，20分钟内碳氧血红蛋白水平显著下降13.8%，同时代谢参数逐步改善。尽管患者最终遭受了不可逆的缺氧缺血性脑损伤，但本病例凸显了在涉及疑似氰化物中毒的紧急复苏情况下推注剂量羟钴胺的潜在效用。
