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OTHER AGENTS
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PRECAUTIONS
Today, there is no medical antidote against cyanide poisoning within the Swedish Armed Forces. The treatment given to civilians is based on encouraging and speeding-up the body's own ability to excrete cyanide and to bind cyanide in the blood.
The enzyme rhodanese is present in the body, mainly in the liver, and together with sulphur transforms cyanide into thiocyanate, which is passed out in the urine.
By supplying sulphur in the form of sodium thiosulphate (Na2S2O3) the detoxification can be speeded up. The cyanide ion has high affinity to trivalent iron (Fe3+).
The divalent iron in blood haemoglobin can be oxidized to trivalent, which leads to the formation of methaemoglobin which binds cyanide ions. The formation of methaemoglobin can be achieved by supplying sodium nitrite (NaNO2) or dimethylaminophenol (DMAP).
Cyanide can also be bound by metallic ions supplied to the blood in suitable form. Among others, cobalt can be supplied in the form of a cobalt complex or as hydroxycobalamin (vitamin B12).
In cases of poisoning with hydrogen cyanide it is of the utmost importance that countermeasures are immediately introduced. For this reason, a medical antidote PAPP, can be used as a pretreatment is being developed in the United Kingdom.