首页|Intramuscular cobinamide as an antidote to methyl mercaptan poisoning
Intramuscular cobinamide as an antidote to methyl mercaptan poisoning
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Background: Methyl mercaptan occurs naturally in the environment and is found in a variety of occupational settings, including the oil, paper, plastics, and pesticides industries. It is a toxic gas and deaths from methyl mercaptan exposure have occurred. The Department of Homeland Security considers it a high threat chemical agent that could be used by terrorists. Unfortunately, no specific treatment exists for methyl mercaptan poisoning. Methods: We conducted a randomized trial in 12 swine comparing no treatment to intramuscular injection of the vitamin B12 analog cobinamide (2.0 mL, 12.5 mg/kg) following acute inhalation of methyl mercaptan gas. Physiological and laboratory parameters were similar in the control and cobina-mide-treated groups at baseline and at the time of treatment. Results: All six cobinamide-treated animals survived, whereas only one of six control animals lived (17% survival) (p = 0.0043). The cobinamide-treated animals returned to a normal breathing pattern by 3.8 ±1.1 min after treatment (mean±SD), while all but one animal in the control group had intermittent gasping, never regaining a normal breathing pattern. Blood pressure and arterial oxygen saturation returned to baseline values within 15 minutes of cobinamide-treatment. Plasma lactate concentration increased progressively until death (10.93 ±6.02 mmol [mean±SD]) in control animals, and decreased toward baseline (3.79 ±2.93 mmol [mean±SD]) by the end of the experiment in cobina-mide-treated animals. Conclusion: We conclude that intramuscular administration of cobinamide improves survival and clinical outcomes in a large animal model of acute, high dose methyl mercaptan poisoning.
Tara B. Hendry-Hofer、Patrick C. Ng、Alison M. McGrath、Kirsten Soules、David S. Mukai、Adriano Chan、Joseph K. Maddry、Carl W. White、Jangwoen Lee、Sari B. Mahon、Matthew Brenner、Gerry R. Boss、Vikhyat S. Bebarta
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Department of Emergency Medicine, University of Colorado, Aurora, CO, USA
NSTL
