Cellular Respiration
Potential Medical Countermeasures
Cobinamide, one of the compounds in the biosynthesis pathway of hydroxocobalamin, is another promising drug that warrants further investigation. Cyanohydrin-forming compounds (e.g., alpha-ketoglutarate and pyruvate) and vasodilatory drugs that act similarly to nitrite compounds are potential new cyanide antidotes, as are drugs that act at the cellular level, such as synthetic S-substituted crystallized rhodanese (an enzyme that promotes the conversion of cyanide to non-toxic thiocyanate). Sulfur-containing medications may also have potential benefits in the treatment of cyanide poisoning, especially those that remain in circulation for longer periods of time than sodium thiosulfate. Drugs that form methemoglobin may have an advantage, but there are significant health risks associated with high levels of methemoglobin.
Several sophisticated cyanide detection methodologies have been developed but these are neither rapid nor widely available.