• M A Kirk, R Gerace, and K W Kulig.
• Rocky Mountain Poison Center, Denver, Colorado.
• Ann Emerg Med. 1993 Sep 1;22(9):1413-8.

Study ObjectiveTo evaluate serial cyanide, methemoglobin, and carbon monoxide levels in smoke inhalation patients.SettingRegional poison center and regional toxicology treatment center.ParticipantsSeven critically ill smoke inhalation patients referred to the regional poison center.InterventionsPeak level and half-life were determined by obtaining serial carboxyhemoglobin, cyanide, and methemoglobin levels.ResultsThe mean observed half-life of cyanide was 3.0 +/- 0.6 hours. Methemoglobinemia was evaluated in four patients after sodium nitrite administration. The peak measured methemoglobin levels (mean, 10.5% +/- 2%; range, 7.9% to 13.4%) did not occur until a mean of 50 minutes (range, 35 to 70 minutes) following administration of sodium nitrite. The total oxygen-carrying capacity reduced by the combination of carboxyhemoglobin and methemoglobin was never more than 21% (range, 10% to 21%) in this series.ConclusionThe administration of sodium nitrite to smoke inhalation patients in the presence of concomitant carbon monoxide poisoning may be relatively safe.

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