Other Potential Sources of Cyanide Exposure

Cyanide: An Essential and Dangerous Component in Industry and Manufacturing

Cyanide (CN) is in any chemical compound that contains the cyano group, which can be found in compounds of gases, solids, or liquids. Those that can release the CN ion (CN-) are highly toxic.24

  • CN poisoning can occur due to both occupational exposure and industrial accidents16
  • RTI International, in coordination with an advisory board of emergency response experts, estimated the US demand for hydrogen cyanide to be 1.838 billion pounds in 200425
  • Over 70 occupations involve the use of, and therefore, potential exposure to CN16
  • According to a 2006 RTI International paper, CN was estimated to be present in over 15,000 chemical plants across the United States25
  • Because liquid and solid forms of CN are transported by rail and highway, accidental exposures can occur en route to or from industrial facilities25
  • CN is also used as an intermediary in production of materials found in25
    • Building construction
    • Transportation vehicle interiors
    • Residential and commercial interiors and furnishings

Cyanide: A Potential Terrorist Weapon

  • Plentiful and easy to obtain and can exist as a gas, liquid, or white crystal powder24,26
  • Does not require special knowledge for use, which increases the number of possible candidates who can implement an attack24
  • A terrorist attack is capable of causing mass confusion, panic, and social disruption25



Indication
CYANOKIT® (hydroxocobalamin for injection) 5 g for intravenous infusion is indicated for the treatment of known or suspected cyanide poisoning. If clinical suspicion of cyanide poisoning is high, CYANOKIT® should be administered without delay.

Important Safety Information
Cyanide poisoning may result from inhalation, ingestion, or dermal exposure. Prior to administration of CYANOKIT®, smoke-inhalation victims should be assessed for: exposure to fire or smoke in an enclosed area; presence of soot around the mouth, nose, or oropharynx, and altered mental status. In addition to CYANOKIT®, treatment of cyanide poisoning must include immediate attention to airway patency, adequacy of oxygenation and hydration, cardiovascular support, and management of any seizure activity.

Use caution in the management of patients with known anaphylactic reactions to hydroxocobalamin or cyanocobalamin. Allergic reactions may include: anaphylaxis, chest tightness, edema, urticaria, pruritus, dyspnea, rash, and angioneurotic edema. Substantial increases in blood pressure may occur following CYANOKIT® therapy. Usage may interfere with some clinical laboratory evaluations. Also, because of its deep red color, hydroxocobalamin may cause hemodialysis machines to shut down due to an erroneous detection of a "blood leak." This should be considered before hemodialysis is initiated in patients treated with hydroxocobalamin. Due to potential photosensitivity, patients should avoid direct sun until erythema resolves.

CYANOKIT® is Pregnancy Category C and should be used during pregnancy only if the potential benefit justifies the potential risk. Safety and effectiveness of CYANOKIT® have not been established in pediatric patients. The most common adverse reactions (>5%) are transient and include chromaturia, erythema, rash (predominantly acneiform), increased blood pressure, nausea, headache, decreased lymphocyte percentage, and injection site reactions.

Please see single 5-g vial full Prescribing Information. Please see two 2.5-g vial full Prescribing Information.

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