Principles of treatment defeats cyanide and its derivatives originate from their mechanism of action and include antidotnye, patogeneti and symptomatic, therapy.

The mechanism of antidote therapy tools can be divided into four groups:

And/metgemoglobinobrazuûŝie tools;

B/substances, containing sulfur;

In/hydrogen acceptors;

G/substances, containing carbohydrates.

Metgemoglobinobrazovateli occupy a leading place in the system of therapeutic interventions, aimed at saving a life poisoned by cyanide. As a metgemoglobinobrazovatelej, the following use of pharmacological drugs: amilnitrit, -propyl nitrite (on 0,5 ml amp.), solution of sodium nitrite (10-15 ml in/in). Sodium nitrite is considered one of the most effective metgemoglobinobrazovatelej. With the introduction of metgemoglobinobrazovatelej hemoglobin in metgemoglobin turns. Metgemoglo bin unlike hemoglobin contains iron trehvalent Noe, Consequently he easily connects with cyanide to form cianmetgemoglobin.

Primarily metgemoglobin connects with cyanide, dissolved in plasma, and stops its move into the tissue. As a result of the equilibrium concentrations of hydrocyanic acid in plasma and tissues, the transition occurs, hydrocyanic acid from the tissues into the bloodstream and connect it with metgemoglobinom. Respiratory enzyme permanently relieved of hydrocyanic acid and restores its activity, that clinically expressed as withdrawal/reduction/phenomenon oxygen breathing 5th

Cianmetgemoglobin later gradually dissociates and free hydrogen cyanide reappears in plasma. However, this process is slow, that allows you to take timely measures for the disposal of cyanide substances, relocate inactive hydrocyanic acid.

Dignity of antidotes to this group:

a/ease of introduction of amilnitrita and propilnitrita in the body;

b/the quickness of their actions;

in/ability to reactivate citohromoksidazu.

Disadvantages:

a/the ability to cause a significant drop in blood pressure, that makes caution when giving medications to persons with inadequate cardiovascular system;

b/the difficulty of creating optimal concentrations of methemoglobin; known, that transformation 20-30% hemoglobin, in metgemoglobin does not cause gemičeskoj forms of hypoxia, unnecessarily. oxygen blood Depot considerably exceeds oxygen request fabrics. However, an overdose of metgemoglobinobra SERS can lead, the massive formation of methemoglobin, that in turn could very complicate for poisoning, and in some cases even cause death;

cianmetgemoglobin-in/connection fragility; formed cianmetgemoglobin after some time/early hours/breaks down into hydrocyanic acid and methemoglobin; when poisoning large doses and treatment of nitrite may be a relapse of poisoning; It is therefore necessary to defuse or neutralize free/dissociated/hydrocyanic acid.

The mechanism of action of methylene blue and sulfur-containing preparations

Their advantages and disadvantages

Hydrogen acceptors. The mechanism of toxicity of hydrocyanic acid accumulation of hydrogen atoms èlektropoložitel′nyh plays the role of a factor, retarding for biological oxidation reactions. In this regard, of great interest is the idea of hydrogen bonding with the aim of overcoming the inhibition of tissue respiration.

Metilenovaâ blue, composed of hromosmona. It was included in the arsenal of tools, used in the treatment of cyanide poisoning. The second representative of this group — Ascorbic acid, is restore LEM, unnecessarily. easily gives off hydrogen, turning into degidroaskorbinovuû acid. The latter biologically very active and can hungrily take hydrogen. Accepted hydrogen interacts with molecular oxygen with the formation of hydrogen peroxide. There is evidence that, that hydrogen peroxide can displace ion ciana from its compounds with iron. On the activity of catalase hydrogen peroxide will decompose with formation of the active oxygen, that goes for the oxidation of hydrocyanic acid in cianovuû. Cyan acid is an unstable connection, It breaks down in the body to carbon dioxide and ammonia.

In high doses, metilenovaâ blue /50 ml or more/have affected cyanide causes formation of methemoglobin, that links ciangruppu, releasing citohromoksidazu. In small doses /10-20 ml/it facilitates the recovery of methemoglobin in the oxyhaemoglobin around the body and is used as a medicine for poisoning metgemoglobinobrazuûŝimi poison.

Dignity of antidotes to this group:

and/metilenovaâ blue and dehydroascorbic acid are catalysts of cellular respiration, as well as translate hydrocyanic acid in non-toxic compound;

b/compared to amilnitritom/propiliitritom/metilenovaâ Blue has a less pronounced gipotenzive effect.

Disadvantages:

a/the need for intravenous methylene blue restricts the use of sho, especially when providing first aid at the scene of the defeat;

b/metilenovaâ blue in high doses causes hemolysis and anemizaciû, Therefore, you must limit the dose/no more 1 mL/kg;

in/in the introduction of a methylene Blue's kidney is not recommended, unnecessarily. the drug has an irritating effect on the renal parenchyma;

g/drugs, This group differ slow speed of detoksicirutego actions and therefore can only be used for neutralization of hydrocyanic acid, from waders migrations is gradually cianmetgemoglobin.

Substances, containing sulfur/sodium thiosulfate 30% r-r, unitiol 5% r-r/. Of sulfur-containing the most effective antidotes proved sodium thiosulfate. In the body of sodium thiosulfate cleaves sulfur, which connects to the cyanide with formation of little of toxic rodanidov. The reaction occurs in the presence of the enzyme rodanezy, contained in the liver, Kidney and brain brain. Sodium thiosulfate is administered intravenously in 50 ml.

Advantage of sulfur-containing drugs is their ability to turn in malotoksičnuû hydrocyanic acid rodanistuû acid, as well as the ability to dramatically improve the efficiency of other methods of therapy.

Serious deficiencies are sodium thiosulfate:

a/the need for intravenous injection in a large dose, that mass income affected by very difficult to perform;

b/the slowness of chipping off sulphur after application in blood flow.

Referring to slow the speed of detoksicirutego action serosoder conducted the preparations as well as, hydrogen acceptors can only be used for neutralization of hydrocyanic acid cianmetgemoglobin of waders migrations.

Glucose has known medicinal properties. Involves camping, glucose reacts by type and aldehyde. In addition, glucose has other useful properties. It has a stimulating effect on the respiration of the interstitial, is a major energy substrate brain tissue, beneficial effect on cardiovascular function of the sosudis system, liver and diuresis. Glucose enhances the therapeutic effect of methylene blue, It is therefore proposed to use a mixture of these chemicals/hromosmon/. Interest also has the ability to transfer glucose metgemoglobin in haemoglobin. Previously reduced concentrations of methemoglobin/in the treatment of cyanide poisoning nitrites/from the introduction of glucose is undesirable, even harmful. Therefore, after the introduction of the nitrites are encouraged to withstand some pause/up 15-30 min./.

Glucose, as sodium thiosulfate and metilenovaâ blue, has the slow speed of detoksiruûŝego action and therefore yourself is only used for neutralization of hydrocyanic acid, waders migrations from the complex cianmetgemoglobin.