Oral Glycine and Sodium Thiosulfate for Lethal Cyanide Ingestion
Matthew Brenner1,2, Sarah M Azer1, Kyung-Jin Oh3, Chang Hoon Ha4, Jangwoen Lee1, Sari B Mahon1, Xiaohua Du5, David Mukai1, Tanya Burney1, Mayer Saidian1,6*, Adriano Chan7, Derek I Straker7, Vikhyat S Bebarta8 and Gerry R Boss7
- *Corresponding Author:
- Mayer Saidian
Beckman Laser Institute
University of California
Irvine, California, USA
E-mail: [email protected]
Received date: June 05, 2017; Accepted date: June 20, 2017; Published date: June 27, 2017
Citation: Brenner M, Azer SM, Oh KJ, Ha CH, Lee J, et al. (2017) Oral Glycine and Sodium Thiosulfate for Lethal Cyanide Ingestion. J Clin Toxicol 7:355. doi: 10.4172/2161-0495.1000355
Copyright: © 2017 Brenner M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Objective: Accidental or intentional cyanide ingestion is an-ever present danger. Rapidly acting, safe, inexpensive oral cyanide antidotes are needed that can neutralize large gastrointestinal cyanide reservoirs. Since humans cannot be exposed to cyanide experimentally, we studied oral cyanide poisoning in rabbits, testing oral sodium thiosulfate with and without gastric alkalization.
Setting: University research laboratory.
Subjects: New Zealand white rabbits.
Interventions: Seven animal groups studied; Groups 1-5 received high dose oral NaCN (50 mg, >LD100) and were treated immediately with oral (via nasogastric tube): 1) saline, 2) glycine, 3) sodium thiosulfate or 4) sodium thiosulfate and glycine, or 5) after 2 min with intramuscular injection of sodium nitrite and sodium thiosulfate plus oral sodium thiosulfate and glycine. Groups 6-7 received moderate dose oral NaCN (25 mg, LD70) and delayed intramuscular 6) saline or 7) sodium nitrite-sodium thiosulfate.
Measurements and Main Results: All animals in the high dose NaCN group receiving oral saline or glycine died very rapidly, with a trend towards delayed death in glycine-treated animals; saline versus glycine-treated animals died at 10.3+3.9 and 14.6+5.9 min, respectively (p=0.13). In contrast, all sodium thiosulfate-treated high dose cyanide animals survived (p<0.01), with more rapid recovery in animals receiving both thiosulfate and glycine, compared to thiosulfate alone (p<0.03). Delayed intramuscular treatment alone in the moderate cyanide dose animals increased survival over control animals from 30% to 71%. Delayed treatment in high dose cyanide animals was not as effective as immediate treatment, but did increase survival time and rescued 29% of animals (p<0.01 versus cyanide alone).
Conclusions: Oral sodium thiosulfate with gastric alkalization rescued animals from lethal doses of ingested cyanide. The combination of oral glycine and sodium thiosulfate may have potential for treating high dose acute cyanide ingestion and merits further investigation. The combination of systemic and oral therapy may provide further options.