Hydroxocobalamin is an effective first-line antidote used mainly in monotherapy of cyanide poisonings, while the opinions are different on the effects of its combination with sodium thiosulfate. A 58-year-old male committed a suicide attempt by ingesting of 1200-1500 mg of potassium cyanide; he was unconscious for 1-1.5 min. after ingestion with the episode of generalized seizures. On admission to the ICU, the patient was acidotic (pH 7.28; HCO3 14.0 mmol/L, base excess -12.7 mmol/L, saturation O2 0.999) with high serum lactate (12.5 mmol/L). Hydroxocobalamin was administered 1.5 hr after ingestion in two subsequent intravenous infusions at a total dose of 7.5 g. The infusion was followed by continuous intravenous administration of 1 mL/hr/kg of 10% sodium thiosulfate at a total dose of 12 g. No complications and adverse reactions were registered. Serum lactate decreased to 0.6 mmol/L the same day, and arterial blood gases became normal (pH 7.49; HCO3 27.2 mmol/L, base excess 2.2 mmol/L, saturation O2 0.994). The follow-up examination 5 months later revealed no damage of basal ganglia and cerebellum on magnetic resonance imaging. The neurological examination revealed no pathological findings. On the ocular coherence tomography, the retinal nerve fibres layer was normal. In visual evoked potentials, there was a normal evoked complex on the left eye and minor decrease in amplitude on the right eye. Combination of hydroxocobalamin and sodium thiosulfate can have a positive effect on the survival without long-term neurological and visual sequelae in the cases of massive cyanide poisonings due to the possibility of a potentiation or synergism of hydroxocobalamin effects by sodium thiosulfate. This synergism can be explained by the different time-points of action of two antidotes: the initial and immediate effect of hydroxocobalamin, followed by the delayed, but more persistent effect of sodium thiosulfate.
- MeSH
- Antidotes administration & dosage therapeutic use MeSH
- Hydroxocobalamin administration & dosage therapeutic use MeSH
- Drug Therapy, Combination MeSH
- Potassium Cyanide poisoning MeSH
- Middle Aged MeSH
- Humans MeSH
- Suicide, Attempted MeSH
- Thiosulfates administration & dosage therapeutic use MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
- Research Support, Non-U.S. Gov't MeSH
- MeSH
- Administration, Oral MeSH
- Biological Availability MeSH
- Models, Biological MeSH
- Biotransformation MeSH
- Renal Dialysis MeSH
- Adult MeSH
- Financing, Organized MeSH
- Glomerular Filtration Rate MeSH
- Injections, Intravenous MeSH
- Cardiovascular Agents administration & dosage pharmacokinetics blood urine MeSH
- Kidney metabolism physiopathology MeSH
- Middle Aged MeSH
- Humans MeSH
- Kidney Diseases metabolism physiopathology therapy MeSH
- Chi-Square Distribution MeSH
- Aged MeSH
- Thiosulfates administration & dosage pharmacokinetics blood urine MeSH
- Chromatography, High Pressure Liquid MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Geographicals
- Switzerland MeSH
Spisy lékařské fakulty Masarykovy university v Brně ; sv. 7/2, 1929, sign. A 62
31 stran : ilustrace, tabulky ; 23 cm
- Conspectus
- Biochemie. Molekulární biologie. Biofyzika
- NML Fields
- biochemie
- NML Publication type
- studie
Thiosulfate dehydrogenase was purified from Acidithiobacillus ferrooxidans using three purification steps. The purification procedure involved ammonium sulfate fractionation, ion-exchange chromatography, and gel permeation chromatography. Specific activity of the purified enzyme (after IEC) was 3.26 nkat/mg, and yield of the enzyme was 78%. The purity of the enzyme was checked by polyacrylamide gel electrophoresis in the presence of sodium dodecyl sulfate. The enzyme is a tetramer composed of four probably identical subunits of relative molecular weight 45,000. The pH optimum of the enzyme reaction in the direction of substrate oxidation was found to be 3.0. The isoelectric point of the enzyme was 8.3. Enzyme activity was found to be particularly sensitive to the histidine-selective reagent diethylpyrocarbonate. Reagents selective for arginine, cysteine, and tryptophane had no effect on enzyme activity.
- MeSH
- Acidithiobacillus enzymology MeSH
- Enzyme Activation drug effects MeSH
- Time Factors MeSH
- Chromatography, Ion Exchange MeSH
- Diethyl Pyrocarbonate pharmacology MeSH
- Sodium Dodecyl Sulfate chemistry MeSH
- Electrophoresis, Polyacrylamide Gel MeSH
- Financing, Organized MeSH
- Chromatography, Gel MeSH
- Histidine pharmacology MeSH
- Isoelectric Point MeSH
- Hydrogen-Ion Concentration MeSH
- Molecular Weight MeSH
- Oxidoreductases chemistry isolation & purification metabolism MeSH
- Ammonium Sulfate chemistry MeSH
- Substrate Specificity MeSH
Kalcifikující uremická arteriolopatie, neboli kalcifylaxe, je raritní onemocnění vyznačující se systémovou kalcifikací médie arteriol vedoucí k ischemii a podkožním nekrózám. Nejčastěji se vyskytuje u pacientů s konečným selháním ledvin v chronickém hemodialyzačním programu (incidence se udává 1–4 %) a po transplantaci ledviny. Kalcifylaxe je zrádná svou rychlou progresí v nekrózu tkáně, obtížným hojením a vysokým rizikem sekundární infekce, která je nejčastější příčinou úmrtí při tomto onemocnění. Úmrtnost se udává v rozmezí 60–80 % v průběhu několika měsíců od stanovení diagnózy. Základem léčebného úspěchu je včasné stanovení diagnózy a správně a trpělivě vedená léčba. Na příkladu 3 pacientů zařazených v našem chronickém hemodialyzačním programu demonstrujeme typické klinické projevy a léčbu kožních defektů při kalcifylaxi, jež vyžaduje těsnou spolupráci pacienta a ošetřujícího personálu. Základem léčby u všech našich pacientů byla korekce kalciofosfátového metabolizmu a sekundární hyperparatyreózy. Na konci dialýz byl všem aplikován tiosulfát sodný. Další důležitou součástí byla péče o ránu, citlivý debridement a intenzivní lokální péče. Po 5–6 měsících došlo k úplnému zhojení kožních defektů u první pacientky, výraznému zlepšení v případě druhého pacienta a progresi u třetí pacientky. Nebyly pozorovány žádné nežádoucí účinky aplikace tiosulfátu sodného.
Calcific uremic arteriolopathy or calciphylaxis is a rare disorder characterized by systemic medial calcification of arterioles that leads to ischemia and subcutaneous necrosis. It most commonly occurs in patients with end-stage renal disease who are on haemodialysis or who have received a renal transplant. Calciphylaxis is dangerous by its fast progression into tissue necrosis, difficult healing process and a great risk of secondary infection which is the most common cause of death in this condition. The reported mortality rates are as high as 60–80 % in a couple of months once it is diagnosed. The key to successful treatment of calciphylaxis is fast diagnosing of the disease and appropriate treatment management. On the examples of three patients from our haemodialysis centre we demonstrate typical clinical manifestation of calciphylaxis and its treatment, which requires close patient-medical staff cooperation. The basic principle of treatment of all our patients was normalization of calcium-phosphate metabolism and secondary hyperparathyroidism. Sodium thiosulfate had been administered to all patients at the end of haemodialysis session. The wound care played another major role with gentle debridement and intensive local care. After five to six months the skin defects resolved in the first patient, partially resolved in the second patient and deteriorated in the third patient. We have observed no side effects of sodium thiosulfate application.
- MeSH
- Patient Compliance MeSH
- Arterioles pathology MeSH
- Bacterial Infections MeSH
- Chronic Disease MeSH
- Kidney Failure, Chronic complications MeSH
- Renal Dialysis MeSH
- Lower Extremity blood supply MeSH
- Wound Healing drug effects MeSH
- Calciphylaxis * diagnosis mortality physiopathology therapy MeSH
- Comorbidity MeSH
- Middle Aged MeSH
- Humans MeSH
- Cause of Death MeSH
- Wounds and Injuries diagnosis etiology nursing therapy MeSH
- Risk Factors MeSH
- Treatment Failure MeSH
- Thiosulfates administration & dosage therapeutic use MeSH
- Treatment Outcome MeSH
- Venous Insufficiency MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
