Management of cyanide toxicity in patients with burns

Burns. 2015 Feb;41(1):18-24. doi: 10.1016/j.burns.2014.06.001. Epub 2014 Jun 30.


The importance of cyanide toxicity as a component of inhalational injury in patients with burns is increasingly being recognised, and its prompt recognition and management is vital for optimising burns survival. The evidence base for the use of cyanide antidotes is limited by a lack of randomised controlled trials in humans, and in addition consideration must be given to the concomitant pathophysiological processes in patients with burns when interpreting the literature. We present a literature review of the evidence base for cyanide antidotes with interpretation in the context of patients with burns. We conclude that hydroxycobalamin should be utilised as the first-line antidote of choice in patients with burns with inhalational injury where features consistent with cyanide toxicity are present.

Keywords: Burns; Cyanide; Dicobalt edetate; Hydroxycobalamin; Inhalation injury; Sodium nitrite; Sodium thiosulphate.

Publication types

  • Review

MeSH terms

  • Adenosine / analogs & derivatives
  • Adenosine / therapeutic use
  • Amyl Nitrite / therapeutic use
  • Burns / complications
  • Burns / therapy
  • Chelating Agents / therapeutic use*
  • Cyanides / poisoning*
  • Edetic Acid / therapeutic use
  • Humans
  • Hydroxocobalamin / therapeutic use
  • Hyperbaric Oxygenation / methods
  • Oxygen Inhalation Therapy / methods
  • Poisoning / complications
  • Poisoning / therapy*
  • Pteridines / therapeutic use
  • Smoke Inhalation Injury / complications
  • Smoke Inhalation Injury / therapy*
  • Sodium Nitrite / therapeutic use
  • Thiosulfates / therapeutic use


  • 4-amino-2,6-dimethyl-8-(2'-deoxy-beta-d-ribofuranosyl)-7(8H)-pteridone
  • Chelating Agents
  • Cyanides
  • Pteridines
  • Thiosulfates
  • cobalt-ethylenediamine tetraacetic acid chelate
  • Amyl Nitrite
  • Edetic Acid
  • sodium thiosulfate
  • Adenosine
  • Sodium Nitrite
  • Hydroxocobalamin