Pediatric cyanide poisoning: Causes, manifestations, management, and unmet needs

Robert J. Geller, Claudia Barthold, Jane A. Saiers, Alan H. Hall

Research output: Contribution to journalReview article

62 Citations (Scopus)

Abstract

Confirmed cases of childhood exposure to cyanide are rare despite multiple potential sources including inhalation of fire smoke, ingestion of toxic household and workplace substances, and ingestion of cyanogenic foods. Because of its infrequent occurrence, medical professionals may have difficulty recognizing cyanide poisoning, confirming its presence, and treating it in pediatric patients. The sources and manifestations of acute cyanide poisoning seem to be qualitatively similar between children and adults, but children may be more vulnerable than adults to poisoning from some sources. The only currently available antidote in the United States (the cyanide antidote kit) has been used successfully in children but has particular risks associated with its use in pediatric patients. Because hemoglobin kinetics vary with age, methemoglobinemia associated with nitrite-based antidotes may be excessive at standard adult dosing in children. A cyanide antidote with a better risk/benefit ratio than the current agent available in the United States is desirable. The vitamin B12 precursor hydroxocobalamin, which has been used in Europe, may prove to be an attractive alternative to the cyanide antidote kit for pediatric patients. In this article we review the available data on the sources, manifestations, and treatment of acute cyanide poisoning in children and discuss unmet needs in the management of pediatric cyanide poisoning.

Original languageEnglish (US)
Pages (from-to)2146-2158
Number of pages13
JournalPediatrics
Volume118
Issue number5
DOIs
StatePublished - Nov 1 2006

Fingerprint

Cyanides
Poisoning
Antidotes
Pediatrics
Eating
Hydroxocobalamin
Methemoglobinemia
Poisons
Information Storage and Retrieval
Vitamin B 12
Nitrites
Smoke
Workplace
Inhalation
Hemoglobins
Odds Ratio
Food

Keywords

  • Antidotes
  • Cyanide
  • Hydroxocobalamin
  • Methemoglobinemia
  • Nitrite
  • Poisoning
  • Smoke inhalation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Pediatric cyanide poisoning : Causes, manifestations, management, and unmet needs. / Geller, Robert J.; Barthold, Claudia; Saiers, Jane A.; Hall, Alan H.

In: Pediatrics, Vol. 118, No. 5, 01.11.2006, p. 2146-2158.

Research output: Contribution to journalReview article

Geller, Robert J. ; Barthold, Claudia ; Saiers, Jane A. ; Hall, Alan H. / Pediatric cyanide poisoning : Causes, manifestations, management, and unmet needs. In: Pediatrics. 2006 ; Vol. 118, No. 5. pp. 2146-2158.
@article{89ff843caaa1448f83b7e576a339b413,
title = "Pediatric cyanide poisoning: Causes, manifestations, management, and unmet needs",
abstract = "Confirmed cases of childhood exposure to cyanide are rare despite multiple potential sources including inhalation of fire smoke, ingestion of toxic household and workplace substances, and ingestion of cyanogenic foods. Because of its infrequent occurrence, medical professionals may have difficulty recognizing cyanide poisoning, confirming its presence, and treating it in pediatric patients. The sources and manifestations of acute cyanide poisoning seem to be qualitatively similar between children and adults, but children may be more vulnerable than adults to poisoning from some sources. The only currently available antidote in the United States (the cyanide antidote kit) has been used successfully in children but has particular risks associated with its use in pediatric patients. Because hemoglobin kinetics vary with age, methemoglobinemia associated with nitrite-based antidotes may be excessive at standard adult dosing in children. A cyanide antidote with a better risk/benefit ratio than the current agent available in the United States is desirable. The vitamin B12 precursor hydroxocobalamin, which has been used in Europe, may prove to be an attractive alternative to the cyanide antidote kit for pediatric patients. In this article we review the available data on the sources, manifestations, and treatment of acute cyanide poisoning in children and discuss unmet needs in the management of pediatric cyanide poisoning.",
keywords = "Antidotes, Cyanide, Hydroxocobalamin, Methemoglobinemia, Nitrite, Poisoning, Smoke inhalation",
author = "Geller, {Robert J.} and Claudia Barthold and Saiers, {Jane A.} and Hall, {Alan H.}",
year = "2006",
month = "11",
day = "1",
doi = "10.1542/peds.2006-1251",
language = "English (US)",
volume = "118",
pages = "2146--2158",
journal = "Pediatrics",
issn = "0031-4005",
publisher = "American Academy of Pediatrics",
number = "5",

}

TY - JOUR

T1 - Pediatric cyanide poisoning

T2 - Causes, manifestations, management, and unmet needs

AU - Geller, Robert J.

AU - Barthold, Claudia

AU - Saiers, Jane A.

AU - Hall, Alan H.

PY - 2006/11/1

Y1 - 2006/11/1

N2 - Confirmed cases of childhood exposure to cyanide are rare despite multiple potential sources including inhalation of fire smoke, ingestion of toxic household and workplace substances, and ingestion of cyanogenic foods. Because of its infrequent occurrence, medical professionals may have difficulty recognizing cyanide poisoning, confirming its presence, and treating it in pediatric patients. The sources and manifestations of acute cyanide poisoning seem to be qualitatively similar between children and adults, but children may be more vulnerable than adults to poisoning from some sources. The only currently available antidote in the United States (the cyanide antidote kit) has been used successfully in children but has particular risks associated with its use in pediatric patients. Because hemoglobin kinetics vary with age, methemoglobinemia associated with nitrite-based antidotes may be excessive at standard adult dosing in children. A cyanide antidote with a better risk/benefit ratio than the current agent available in the United States is desirable. The vitamin B12 precursor hydroxocobalamin, which has been used in Europe, may prove to be an attractive alternative to the cyanide antidote kit for pediatric patients. In this article we review the available data on the sources, manifestations, and treatment of acute cyanide poisoning in children and discuss unmet needs in the management of pediatric cyanide poisoning.

AB - Confirmed cases of childhood exposure to cyanide are rare despite multiple potential sources including inhalation of fire smoke, ingestion of toxic household and workplace substances, and ingestion of cyanogenic foods. Because of its infrequent occurrence, medical professionals may have difficulty recognizing cyanide poisoning, confirming its presence, and treating it in pediatric patients. The sources and manifestations of acute cyanide poisoning seem to be qualitatively similar between children and adults, but children may be more vulnerable than adults to poisoning from some sources. The only currently available antidote in the United States (the cyanide antidote kit) has been used successfully in children but has particular risks associated with its use in pediatric patients. Because hemoglobin kinetics vary with age, methemoglobinemia associated with nitrite-based antidotes may be excessive at standard adult dosing in children. A cyanide antidote with a better risk/benefit ratio than the current agent available in the United States is desirable. The vitamin B12 precursor hydroxocobalamin, which has been used in Europe, may prove to be an attractive alternative to the cyanide antidote kit for pediatric patients. In this article we review the available data on the sources, manifestations, and treatment of acute cyanide poisoning in children and discuss unmet needs in the management of pediatric cyanide poisoning.

KW - Antidotes

KW - Cyanide

KW - Hydroxocobalamin

KW - Methemoglobinemia

KW - Nitrite

KW - Poisoning

KW - Smoke inhalation

UR - http://www.scopus.com/inward/record.url?scp=33750932014&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33750932014&partnerID=8YFLogxK

U2 - 10.1542/peds.2006-1251

DO - 10.1542/peds.2006-1251

M3 - Review article

C2 - 17079589

AN - SCOPUS:33750932014

VL - 118

SP - 2146

EP - 2158

JO - Pediatrics

JF - Pediatrics

SN - 0031-4005

IS - 5

ER -