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Title: Intramuscular aminotetrazole cobinamide as a treatment for inhaled hydrogen sulfide poisoning in a large swine model.

Authors: Hendry-Hofer, Tara B; Ng, Patrick C; McGrath, Alison M; Mukai, David; Brenner, Matthew; Mahon, Sari; Maddry, Joseph K; Boss, Gerry R; Bebarta, Vikhyat S

Published In Ann N Y Acad Sci, (2020 11)

Abstract: Hydrogen sulfide (H2 S), a high-threat chemical agent, occurs naturally in a variety of settings. Despite multiple incidents of exposures and deaths, no FDA-approved antidote exists. A rapid-acting, easy to administer antidote is needed. We conducted a randomized control trial in swine comparing intramuscular administration of aminotetrazole cobinamide (2.9 mL, 18 mg/kg) to no treatment following inhalation of H2 S gas. We found that aminotetrazole cobinamide administered 2 min after the onset of respiratory depression-defined as a tidal volume of less than 3 mL/kg for 2 consecutive minutes-yielded 100% survival, while all control animals died. Respiratory depression resolved in the treatment group within 3.6 ± 1.5 min (mean ± SD) of cobinamide administration, whereas control animals had intermittent gasping until death. Blood pressure and arterial oxygen saturation (SO2 ) returned to baseline values within 5 and 10 min, respectively, of cobinamide treatment, and plasma lactate concentration decreased to less than 50% of the highest value by the end of the experiment. In control animals, plasma lactate rose continuously until death. We conclude that intramuscular aminotetrazole cobinamide is effective in a large animal, inhalational model of acute, severe H2 S poisoning.

PubMed ID: 32233102 Exiting the NIEHS site

MeSH Terms: Animals; Antidotes/pharmacology*; Cobamides/pharmacology*; Humans; Hydrogen Sulfide/poisoning*; Injections, Intramuscular; Male; Swine; Thiadiazoles/pharmacology*

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