Change in National Dosing Advice of Nitroprusside After Potentially Fatal Cyanide Intoxication

Abstract

The aim of this brief communication is to provide a short overview of cyanide intoxication following infusion of sodium nitroprusside (SNP). SNP is a fast-acting antihypertensive drug frequently used in of hypertensive emergencies. Although SNP is widely known as a safe to use drug, it can cause a potentially lethal cyanide intoxication. The difficulty to diagnose cyanide intoxication and pharmacological principles will be discussed. Hereby, we like to regain attention for this severe complication. As a result of our experience, the Dutch national paediatric drug formulary has been updated with additional warnings and recommendations. Cyanide intoxication due to sodium nitroprusside is a severe and difficult to recognize complication with potentially lethal outcome. Clinicians prescribing sodium nitroprusside should always be aware of its toxic effects.