Sodium nitroprusside-associated cyanide toxicity in adult patients – Fact or fiction? A critical review of the evidence and clinical relevance

Open Access Journal of Clinical Trials

Volumn 2, Issue , 2010, Pages 133-148

  Lockwood, Alissa ^a   Patka, John ^b   Rabinovich, Marina ^b   Wyatt, Katleen ^b   Abraham, Prasad ^b  

^a Parkland Health and Hospital Systems   (United States)

^b GRADY HEALTH SYSTEM   (United States)

Author keywords

Controversy; Cyanide levels; Dose limits; Monitoring; Thiosulfate stores

Indexed keywords

CYANIDE; CYCLIC GMP; LACTIC ACID; NITROPRUSSIDE SODIUM; THIOSULFATE SULFURTRANSFERASE;

CORONARY ARTERY BYPASS GRAFT; CYANIDE POISONING; DETOXIFICATION; DRUG OVERDOSE; FLUSHING; HUMAN; HYPERTENSION; INFUSION RATE; LACTIC ACIDOSIS; MORTALITY; OXIDATIVE PHOSPHORYLATION; POSTOPERATIVE CARE; PROPHYLAXIS; RANDOMIZED CONTROLLED TRIAL (TOPIC); RECOMMENDED DRUG DOSE; REVIEW; TACHYCARDIA; VASODILATATION;

EID: 84939436985     PISSN: None     EISSN: 11791519     Source Type: Journal    
DOI: 10.2147/OAJCT.S7573     Document Type: Review

References (125)

1. Tinker JH, Michenfelder JD. Sodium nitroprusside: pharmacology, toxicology, and therapeutics. Anesthesiology. 1976;45:340-354.
2. Friedrich JA, Butterworth JF IV. Sodium nitroprusside: twenty years and counting. Anesth Analg. 1995;81:152-162.
3. Marik PD, Varon J. Hypertensive crisis: challenges and management. Chest. 2007;131:1949-1962.
4. Broderick J, et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Stroke. 2007;38:2001-2023.
5. Adams HP, Adams RJ, Brott T, et al. Guidelines for the early management of patients with ischemic stroke. A scientific statement from the Stroke Council of the American Stroke Association. Stroke. 2003;34:1056-1083.
6. Rhoney D, Peacock WF. Intravenous therapy for hypertensive emergencies, part I. Am J Health Syst Pharm. 2009;66:1343-1352.
7. Ivankovich AD, Miletich DJ, Tinker JH. Sodium nitroprusside: metabolism and general considerations. Int Anesthesiol Clin. 1978; 16:1-29.
8. Smith RP, Kruszyna H. Nitroprusside produces CN poisoning via reaction with hemoglobin. J Pharmacol Exp Ther. 1974;191: 557-563.
9. Moncada S, Palmer RM, Higgs EA. Nitric oxide: physiology, pathophysiology and pharmacology. Pharmacol Rev. 1991;43: 109-142.
10. Palmer RM, Ferrige AG, Moncada S. Nitric oxide release accounts for the biological activity of endothelium-derived relaxing factor. Nature. 1987;327:524-526.
11. Hall VA, Guest JM. Sodium nitroprusside-induced CN intoxication and prevention with sodium thiosulfate prophylaxis. Am J Crit Care. 1992;1:19-27.
12. Himwich WA, Saunders JP. Enzymatic conversion of CN to thiocyanate. Am J Physiol. 1948;153:348.
13. Schulz V. Clinical pharmacokinetics of nitroprusside, CN, thiosulfate and thiocyanate. Clin Pharmacokin. 1984;9:239-251.
14. Schulz V, Bonn R, Kindler J. Kinetics of elimination of thicyanate in 7 healthy subjects and 8 subjects with renal failure. Klin Woehenschr. 1979;57:243-247.
15. Vincent M, Vincent F, Marka C, et al. CN and its relationship to nervous suffering: physiopathological aspects of intoxication. Clin Toxicol. 1981;18:1519-1527.
16. Curry SC, Arnold-Capell P. Nitroprusside, nitroglycerin and angiotensin-converting enzyme inhibitors. Crit Care Clin. 1991;7: 555-581.
17. Kun E. The Metabolism of Sulfur-Containing Compounds. Metabolic Pathways. New York: Academic Press; 1961.
18. Ivankovich AD, et al. Sodium thiosulfate disposition in humans: relation to sodium nitroprusside toxicity. Anesthesiology. 1983;58:11-17.
19. Kulig K. CN antidotes and fire toxicology. N Engl J Med. 1991;325: 1801-1802.
20. Vogel SN, Sultan TR. CN poisoning. Clin Toxicol. 1981;18(3): 367-383.
21. Salkowski AA, Penney DG. Metabolic, cardiovascular, and neurologic aspects of acute CN poisoning in the rat. Toxicol Lett. 1995;75: 19-27.
22. Baud FJ, et al. Value of lactic acidosis in the assessment of the severity of acute CN poisoning. Crit Care Med. 2002;30(9):2044-2050.
23. Baud FJ, et al. Elevated blood CN concentrations in victims of smoke inhalation. N Engl J Med. 1991;325:1761-1766.
24. Graham DL, et al. Acute CN poisoning complicated by lactic acidosis and pulmonary edema. Arch Intern Med. 1977;137:1051-1055.
25. Hall AH, Rumack BH. Clinical toxicology of CN. Ann Emerg Med. 1986;1067-1074.
26. Davies DW, et al. A sudden death associated with the use of sodium nitroprusside for induction of hypotension during anaesthesia. Canad Anaesth Soc J. 1975;22:547-552.
27. Merrifield AY, Blundell MD. Toxicity of sodium nitroprusside. Br J Anaesth. 1974;46:324.
28. Jack RD. Toxicity of sodium nitroprusside. Br J Anaesth. 1974; 46:952.
29. Kim YH, et al. CN encephalopathy following therapy with sodium nitroprusside. Arch Pathol Lab Med. 1982;106:392-393.
30. Posner MA, et al. CN production during nitroprusside therapy in an oliguric patient. Anesth Analg.1977;56:729-731.
31. Montoliu J, et al. Fatal hypotension in normal-dose nitroprusside therapy. Amer Heart J. 1979;97:541-542.
32. Sipe EK, et al. CN toxicity in the surgical intensive care unit: a case report. Am Surg. 2001;67:684-686.
33. Schulz V, Roth B. Detoxification of CN in a new-born child. Klin Woehenschr. 1982;60:527-528.
34. Rieves RD. Importance of symptoms in recognizing nitroprusside toxicity. South Med J. 1984;77:1035-1037.
35. Macrae WR, Owen M. Severe metabolic acidosis following hypotension induced with sodium nitroprusside. Br J Anaesth. 1974;46:795-797.
36. Amaranath L, Kellermeyer WF. Tachyphylaxis to sodium nitroprusside. Anesthesiology. 1976;44:345.
37. Perschau RA, et al. Suspected sodium nitroprusside-induced CN intoxication. Anesth Analg. 1977;56:533-537.
38. Marbury TC, et al. Combined antidotal and hemodialysis treatment for nitroprusside-induced CN toxicity. J Toxicol Clin Toxicol. 1982;5: 475-482.
39. Mellino M, Phillips DF. Severe lactic acidosis in a case of nitroprusside resistance. Clev Clin Quar. 1980;47:119-122.
40. Ram Z, et al. Delayed postoperative neurological deterioration from prolonged sodium nitroprusside administration. J Neurosurg. 1989;71: 605-607.
41. Cetnarowski AB, Conti DR. Nitroprusside toxicity and low-dose infusion. Ann Intern Med. 1986;104:895-896.
42. Rausgher LA, et al. Nitroprusside toxicity in a renal transplant patient. Anesthesiology. 1978;49:428-430.
43. Mandragos C, et al. Prolonged high-dose administration of sodium nitroprusside in the intensive care unit. Intensive Care Med. 1998; 24:889.
44. Humphries SH, Nash DA. Lactic acidosis complicating sodium nitroprusside therapy. Ann Intern Med. 1978;88:58.
45. Elberg AJ, et al. Prolonged nitroprusside and intermittent hemodialysis as therapy for intractable hypertension. Am J Dis Child. 1978; 132:988-989.
46. Patel CB, et al. Use of sodium nitroprusside in post-coronary bypass surgery: a plea for conservatism. Chest. 1986;89:663-667.
47. Robin ED, McCauley R. Nitroprusside-related CN poisoning: time (long past due) for urgent, effective interventions. Chest. 1992;102: 1842-1845.
48. Sarvotham SS. Nitroprusside therapy in post-open heart hypertensives: a ritual tryst with CN death? [letter]. Chest. 1987;91:796.
49. McRae WR. Nitroprusside-induced metabolic acidosis [letter]. Anesthesiology. 1976;45:578-579.
50. Vesey CJ, Cole PV, Simpson PJ. Cyanide and thiocyanate concentrations following sodium nitroprusside infusion in man. Br J Anaesth. 1976;48:651-660.
51. Thompson GE, et al. Hypotensive anesthesia for total hip arthroplasty: A study of blood loss and organ function (brain, heart, liver and kidney). Anesthesiology. 1978;48:91-96.
52. Pasch T, Schulz V, Hoppelshauser G. Nitroprusside-induced formation of cyanide and its detoxification with thiosulfate during deliberate hypotension. J Cardiovasc Pharmacol. 1983;5:77-85.
53. Fahmy NR. Nitroprusside vs a nitroprusside trimethaphan mixture for induced hypotension: hemodynamic effects and CN release. Clin Pharmacol Ther. 1985;37:264-270.
54. Corr L, et al. Plasma catecholamine changes during cardiopulmonary bypass: A randomized, double blind comparison of trimetaphan camsylate and sodium nitroprusside. Br Heart J. 1986; 56:89-93.
55. Bernard JM, et al. Systemic haemodynamic and metabolic effects of deliberate hypotension with isoflurane anaethesia or sodium nitroprusside during total hip arthroplasty. Can J Anaesth. 1987;34: 135-140.
56. Cole PV, Vesey CJ. Sodium thiosulfate decreases blood cyanide concentrations after the infusion of sodium nitroprusside. Br J Anaesth. 1987;59:531-535.
57. Simpson DL, et al. Acute beta-adrenoceptor blockade and induced hypotension. Anesthesiology. 1987;42:243-248.
58. van Wezel HB, et al. Myocardial metabolism and coronary sinus blood flow during coronary artery surgery: effects of nitroprusside and nifedipine. Am Heart J. 1987;113:266-273.
59. van Wezel HB, Bovill JG, Visser CA, et al. Myocardial metabolism, catecholamine balance, and left ventricular function during coronary artery surgery: effects of nitroprusside and nifedipine. J Cardiothorac Vasc Anesth. 1987;1(5):408-417.
60. Porter SS, Asher M, Fox DK. Comparison of intravenous nitroprusside, nitroprusside-captopril, and nitroglycerin for deliberate hypotension during posterior spine fusion in adults. J Clin Anesth. 1988;1(2): 87-95.
61. Hodsman NBA, et al. Effect of ketanserin on sodium nitroprusside requirements, arterial pressure control and heart rate following coronary artery bypass surger. Br J Anaesth. 1989;62: 527-531.
62. Geniton DJ. A comparison of the hemodynamic effects of labetalol and sodium nitroprusside in patients undergoing carotid endarterectomy. J Am Ass Nur Anesth. 1990;58:281-287.
63. Godet G, Bertrand M, Coriat P, Kieffer E, Mouren S, Viars P. Comparison of isoflurane with sodium nitroprusside for controlling hypertension during thoracic aortic cross-clamping. J Cardiothorac Vasc Anesth. 1990;4(2):177-184.
64. Ornstein E, et al. Deliberate hypotension in patients with intracranial arteriovenous malformations: esmolol compared with isoflurane and nitroprusside. Anesth Analg. 1991;72:639-644.
65. Owall A, Sollevi A. Myocardial effects of adenosine and sodium nitroprusside-induced hypotension: a comparative study in patients anaesthetized for abdominal aortic aneurysm surgery. Acta Anaesthsiol Scand. 1991;35:216-220.
66. Blau WS, Kafer ER, Anderson JA. Esmolol is more effective than sodium nitroprusside in reducing blood loss during orthognathic surgery. Anesth Analg. 1992;75:172-178.
67. Chaudhri S, et al. Evaluation of closed loop control of arterial pressure during hypotensive anaesthesia for local resection of intraocular melanoma. Br J Anaesth. 1992;69:607-610.
68. Bernard J, et al. Diltiazem reduces the dose requirements for nitroprusside induced hypotension. Anesth Analg.1993;77:318-323.
69. Dentz ME, Lubarsky DA, Smith LR, et al. A comparison of amrinone with sodium nitroprusside for control of hemodynamics during infrarenal abdominal aortic surgery. J Cardiothorac Vasc Anesth. 1995;9(5):486-490.
70. Newton MC, et al. Metabolic and hormonal responses to induced hypotension for middle ear surgery. Br J Anaesth. 1996;76:352-357.
71. van der Stroom JG, van Wezel HB, Vergroesen I, et al. Comparison of the effects of urapidil and sodium nitroprusside on haemodynamic state, myocardial metabolism and function in patients during coronary artery surgery. Br J Anaesth. 1996;76:645-651.
72. Tugrul M, Pembeci K, Camci E, Ozkan T, Telci L. Comparison of the effects of sodium nitroprusside and isoflurane during rewarming on cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 1997;11(6): 712-717.
73. Deakin CD, Petley GW, Smith D. Pharmacologic vasodilatation improves efficiency of rewarming from hypothermic cardiopulmonary bypass. Br J Anaesth. 1998;81:147-151.
74. Suttner SW, et al. The effects of sodium nitroprusside induced hypotension on splanchnic perfusion and hepatocellular integrity. Anesth Analg. 1999;89:1371-1377.
75. Armstrong, et al. Vasodilator therapy in acute myocardial infarction. A comparison of sodium nitroprusside and nitroglycerin. Circulation. 1975;52:1118-1122.
76. Kotter V, Von Leitner ER, Wunderlich J, Schroder R. Comparison of haemodynamic effects of phentolamine, sodium nitroprusside, and glyceryl trinitrate in acute myocardial infarction. Br Heart J. 1977;39: 1196-1204.
77. Cohn JN, et al. Effect of short-term infusion of sodium nitroprusside on mortality rate in acute myocardial infarction complicated by left ventricular failure. New Engl J Med. 1982;306:1129-1135.
78. Durrer JD, et al. Effect of sodium nitroprusside on mortality in acute myocardial infarction. New Engl J Med. 1982;306:1121-1128.
79. Schulz V, et al. Cyanide toxicity of sodium nitroprusside in therapeutic use with and without sodium thiosulfate. Klin Woehenschr. 1982;60: 1393-1400.
80. Flaherty JT. Comparison of intravenous nitroglycerin and sodium nitroprusside in acute myocardial infarction. Am J Med. 1983:53-60.
81. Gray RJ, Bateman TM, Czer LSC, Conklin C, Matloff JM. Use of esmolol in hypertension after cardiac surgery. Am J Cardiol. 1985;56: 49F-56F.
82. Vesey CJ, Cole PV. Blood cyanide and thiocyanate concentrations produced by long-term therapy with sodium nitroprusside. Br J Anaesth. 1985;57:148-155.
83. Gray RJ, et al. Comparison of esmolol and nitroprusside for acute postcardiac surgical hypertension. Am J Cardiol. 1987;59:887-891.
84. Installe E, et al. Comparable effects on hemodynamics of enxoamine, dobutamine and nitroprusside in severe congestive heart failure. Am J Cardiol. 1987:60:46C-52C.
85. Breisblatt WM, et al. Comparable effects of intravenous nitroglycerin and intravenous nitroprusside in acute ischemia. Am Heart J. 1988;166:465.
86. Mullen JC, et al. Postoperative hypertension: A comparison of diltiazem, nifedipine and nitroprusside. J Thorac Cardiovasc Surg. 1988;96:122-132.
87. Underwood SM, et al. Use of isradipine in hypertension following coronary artery bypass surgery. Am J Med. 1989;86:81-87.
88. David D, Dubois C, Loria Y. Comparison of nicardipine and sodium nitroprusside in the treatment of paroxysmal hypertension following aortocoronary bypass surgery. J Cardiothorac Vasc Anesth. 1991; 5(4):357-361.
89. Underwood SM, Davies SW, Feneck RO, Lunnon MW, Walesby RK. Comparison of isradipine with nitroprusside for control of blood pressure following myocardial revascularization: effects on hemodynamics, cardiac metabolism, and coronary blood flow. J Cardiothorac Vasc Anesth.1991;5(4):348-356.
90. Chitwood WR, et al. Multicenter Trial of automated nitroprusside infusion for postoperative hypertension. Ann Thorac Surg. 1992;54: 517-522.
91. Combes P, Durand M. Comparison of nicardipine to sodium nitroprusside in the treatment of hypertension after coronary bypass surgery (a pilot study). Acta Anaesth Belg. 1992;43:113-119.
92. Gretler DD, et al. Electrocardiographic changes during acute treatment of hypertensive emergencies with sodium nitroprusside on fenoldopam. Arch Intern Med. 1992;152:2445-2448.
93. Nathan HJ, et al. Intravenous nifedipine to treat hypertension after coronary artery revascularization surgery; a comparison with sodium nitroprusside. Anesth Analg. 1992;74:809-817.
94. Ruegg PC, et al. Isradipine for the treatment of hypertension following coronary artery bypass graft surgery: a randomized trial versus sodium nitroprusside. Eur J Anaethesiol. 1992;9:293-305.
95. Hill AJ, Feneck RO, Walesby RK. A comparison of fenoldopam and nitroprusside in the control of hypertension following coronary artery surgery. J Cardiothorac Vasc Anesth. 1993;7(3):279-284.
96. Lestrade LA, Chan E, De Lange S. Comparative study of isradipine and sodium nitroprusside in the control of hypertension in patients following coronary artery-bypass surgery. Anaesthesiol Scand. 1993;37 Suppl 99:S48-S52.
97. Pilmer BL, Green JA, Panacek EA, et al. Fenoldopam mesylate versus sodium nitroprusside in the acute management of severe systemic hypertension. J Clin Pharmacol. 1993;33:549-553.
98. Panacek EA, et al. Randomized, prospective trial of fenoldapam versus sodium nitroprusside in the treatment of acute severe hypertension. Acad Emerg Med. 1995;2:959-965.
99. Hirschl MM, et al. Safety and efficacy of urapadil and sodium nitroprusside in the treatment of hypertensive emergencies. Intensive Care Med. 1997;23:885-888.
100. Nagahara N, Li Q, Sawada N. Do antidotes for acute CN poisoning act on mercaptopyruvate sulfurtransferase to facilitate detoxification? Curr DrugTargets Immune Endocr Metabol Disord. 2003;3(3):198-204.
101. Westley J. Rhodanese. Adv Enzymol Relat Areas Mol Biol. 1973;39: 327-368.
102. Westley J, et al. The sulfur transferases. Fund Appl Toxicol. 1983; 3: 377-382.
103. Schneider JF, Westley J. Metabolic interrelations of sulfur in proteins, thiosulfate and cystine. J Biol Chem. 1969;244:5735-5744.
104. Way JL. CN intoxication and its mechanism of antagonism. Ann Rev Pharmacol Toxicol. 1984;24:451-481.
105. Way JL, Sylvester D, Morgan RL, et al. Recent perspectives on the toxicodynamic basis of CN antagonism. Fundam Appl Toxicol. 1984; 4(2 Pt 2):S231-S239.
106. Beasley DM, Glass WI. CN poisoning: pathophysiology and treatment recommendations. Occup Med (Lond). 1998;48(7):427-431.
107. Isom GE, Way JL. Lethality of CN in the absence of inhibition of liver cytochrome oxidase. Biochem Pharmacol. 1976;25:605-608.
108. Piantadosi CA, Sylvia AL. Cerebral cytochrome a,a3 inhibition by CN in bloodless rats. Toxicol. 1984;33:67-79.
109. Sorbo B. On the catalytic effect of blood serum on the reaction between colloidal sulfur and CN. Acta Chem Scand. 1955;1656-1660.
110. Vennesland B, et al. CN metabolism. Fed Proceed. 1981;41: 2639-2648.
111. Silverman SH, et al. CN toxicity in burned patients. J Trauma. 1988; 28:171-176.
112. The Food and Drug Administration. New labeling for sodium nitroprusside emphasized risk of CN toxicity. JAMA. 1991;265:847.
113. Zerbe NF, Wagner BK. Use of vitamin B12 in the treatment and prevention of nitroprusside-induced CN toxicity. Crit Care Med. 1993;21: 465-467.
114. Vesey CJ, Krapex JR, Cole PV. The effects of sodium nitroprusside and cyanide on hemoglobin function. J Pharm Pharmacol. 1980;32:256-261.
115. Holstege CP, Isom GE, Kirk MA. Cyanide and hydrogen sulfide. In: Goldfranks's Toxicological Emergencies. 8th ed. McGraw- Hill companies Inc; c2006. http://online.statref.com. Accessed Apr 2010.
116. Michenfelder J. Cyanide release from sodium nitroprusside in the dog. Anesthesiology. 1977;46:196-201.
117. Osuntokun BO. Ataxic neuropathy associated with high cassava diets in West Africa; in chronic CN toxicity. Ottawa, Canada. 1973:127.
118. Wolfe SK, Swineheart JH. Photochemistry of pentacyanonitrosylferrate, nitroprusside. Inorg Chem. 1973;14:1049.
119. Bisset WIK, et al. Sodium nitroprusside and CN release: reasons for re-appraisal. Br J Anaesth. 1981;53:1015-1017.
120. Hasuike Y, et al. Accumulation of CN and thiocyanate in haemodialysis patients. Nephrol Dial Transplant. 2004;19:1474-1479.
121. Vesey CJ, et al. Metabolism of sodium nitroprusside and CN in the dog. Br J Anaesth. 1979;89-97.
122. Curry AS. CN poisoning. Acta Pharmacol Toxicol. 1963;20: 291-294.
123. Trunkey DD. Inhalation injury. Surg Clin North Am. 1978;58: 1133-1140.
124. McEvoy GK. American hospital formulary service. Drug Inf. 1994;24: 1163-1166.
125. Chiodi H, Collier C, Mohler J. In vitro methemoglobin formation in human blood exposed to NO2. Environ Res. 1983;30:9-15.