PMID: 589503Nov 1, 1977

Cyanide toxicity following nitroprusside induced hypotension

Canadian Anaesthetists' Society Journal
D AitkenB Benoit

Abstract

Several recently reported deaths following the use of sodium nitroprusside have been attributed to the accumulation of the nitroprusside metabolite, cyanide. In this study, brief nitroprusside infusions (mean = 36 minutes) were administered in currently recommended doses during intracranial surgery. The peak blood cyanide following the infusions was 65.2 +/- 17.5 microgram per cent (mean +/- SE) (n = 13). It occurred within 45 minutes after infusion. The highest cyanide level detected was 205 microgram per cent, which is within the range of reported lethal blood cyanide levels. Metabolic acidosis developed in the four patients with the highest blood cyanide levels (range 90-205 microgram per cent). This occurred between 45 and 180 minutes following the cyanide peak. Blood ATP levels were depressed in the same patients. These findings are indicative of disturbed aerobic metabolism. We conclude that there is evidence of cyanide toxicity when nitroprusside is infused into patients using currently recommended doses. We recommend that for short infusions the dose of sodium nitroprusside should not exceed 0.5 mg/kg.

References

Jul 1, 1976·British Journal of Anaesthesia·C J VeseyP J Simpson
Sep 1, 1976·Canadian Anaesthetists' Society Journal·L GreissD W Davies
Mar 1, 1977·Anesthesiology·J D Michenfelder
Sep 1, 1976·Anesthesiology·J H Tinker, J D Michenfelder
Jun 7, 1975·British Medical Journal
Sep 1, 1975·Canadian Anaesthetists' Society Journal·D W DaviesD J Steward
May 1, 1974·British Journal of Anaesthesia·D G McDowallY Okuda
Apr 5, 1973·The New England Journal of Medicine·M E MillerF Stohlman
Jan 1, 1973·Journal of the Neurological Sciences·A J ZamoraM H Kyu
May 1, 1971·The American Journal of Physiology·J A Krasney
Jul 1, 1967·Journal of Clinical Pathology·P G Hill, H G Sammons

Citations

Mar 1, 1978·Anesthesia Progress·R S Garrison
Aug 8, 2008·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Catherine QuinlanAtif Awan
Mar 1, 1981·Clinical Toxicology·S N VogelR P Ten Eyck
Jul 1, 1983·The American Journal of Emergency Medicine·T L LitovitzR A Myers
Jul 1, 1983·Clinics in Endocrinology and Metabolism·R A Kreisberg, B C Wood
Apr 1, 1992·The Annals of Pharmacotherapy·J P Rindone, E P Sloane
Aug 20, 2018·Journal of Molecular Modeling·Gurleen Kaur Walia, Deep Kamal Kaur Randhawa
Sep 1, 1978·Canadian Anaesthetists' Society Journal·P M McGarry
Jul 1, 1982·Journal of Toxicology. Clinical Toxicology·T C MarburyC S Lee
Sep 1, 1979·Canadian Anaesthetists' Society Journal·J du CailarP Chardon
Jan 29, 2021·Journal of Environmental Science and Health. Part. B, Pesticides, Food Contaminants, and Agricultural Wastes·Radoslav OmelkaMonika Martiniakova

Related Concepts

Metabolic Acidosis
Teens
Blood Gas Analysis
Isocyanides
Ferricyanides
Hypotension, Controlled
Nitriate
Thiocyanates

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