When There's Smoke, There May be Cyanide

A Toxin in Closed-Space Fire Smoke

  • Although carbon monoxide is a well-known toxin in fire smoke, cyanide (CN) is an underappreciated danger2
  • Smoke inhalation is the most common cause of acute CN poisoning16
  • Cyanide is frequently found in the smoke of closed-space fires2
    • In a meta-analysis of major fire emergencies over a 19-year period, CN was found at toxic-to-lethal levels in the blood of approximately 33% to 87% of fatalities17
    • CN can be released by virtually any material containing carbon and nitrogen when burned under high temperature and low oxygen conditions18
    • There is potential for CN toxicity due to the increased use of synthetic materials that produce CN during combustion in closed-space fires19

Common Building Materials Known to Release High Levels of CN During Combustion*20

COMMON BUILDING MATERIALS KNOWN TO RELEASE VARYING LEVELS OF CN DURING COMBUSTION*

                           *Items pictured may not be accurate representations.


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.

DISCLAIMER
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