Korean J Pediatr.  2010 Aug;53(8):805-808. 10.3345/kjp.2010.53.8.805.

Successful treatment by exchange transfusion of a young infant with sodium nitroprusside poisoning

• Baek JG
• Jeong HL
• Park JS
• Seo JH
• Park ES
• Lim JY
• Park CH
• Woo HO
• Youn HS
• Yeom JS

• KMID: 2280937
• DOI: http://doi.org/10.3345/kjp.2010.53.8.805

Abstract

Although sodium nitroprusside (SNP) is often used in pediatric intensive care units, cyanide toxicity can occur after SNP treatment. To treat SNP-induced cyanide poisoning, antidotes such as amyl nitrite, sodium nitrite, sodium thiosulfate, and hydroxycobalamin should be administered immediately after diagnosis. Here, we report the first case of a very young infant whose SNP-induced cyanide poisoning was successfully treated by exchange transfusion. The success of this alternative method may be related to the fact that exchange transfusion not only removes the cyanide from the blood but also activates detoxification systems by supplying sulfur-rich plasma. Moreover, exchange transfusion replaces cyanide-contaminated erythrocytes with fresh erythrocytes, thereby improving the blood's oxygen carrying capacity more rapidly than antidote therapy. Therefore, we believe that exchange transfusion might be an effective therapeutic modality for critical cases of cyanide poisoning.

Keyword

Nitroprusside; Exchange transfusion; Cyanides; Poisoning; Detoxification; Infant

MeSH Terms

Amyl Nitrite
Antidotes
Natural Resources
Cyanides
Erythrocytes
Humans
Hydroxocobalamin
Infant
Intensive Care Units, Pediatric
Nitroprusside
Oxygen
Plasma
Sodium
Sodium Nitrite
Thiosulfates
Amyl Nitrite
Antidotes
Cyanides
Hydroxocobalamin
Nitroprusside
Oxygen
Sodium
Sodium Nitrite
Thiosulfates