Antidote Of Potassium

[Laura N Gerard]

Your doctor will look at whether you need to stop taking other medications in order to lower your blood potassium levels, or adjust how much you take. That happens because these drugs contribute to higher potassium.

First Responders should use a NIOSH-certified Chemical, Biological, Radiological, Nuclear (CBRN) Self Contained Breathing Apparatus (SCBA) with a Level A protective suit when entering an area with an unknown contaminant or when entering an area where the concentration of the contaminant is unknown. Level A protection should be used until monitoring results confirm the contaminant and the concentration of the contaminant.
NOTE: Safe use of protective clothing and equipment requires specific skills developed through training and experience.

Select when the greatest level of skin, respiratory, and eye protection is required. This is the maximum protection for workers in danger of exposure to unknown chemical hazards or levels above the IDLH or greater than the AEGL-2.

Select when the highest level of respiratory protection is necessary but a lesser level of skin protection is required. This is the minimum protection for workers in danger of exposure to unknown chemical hazards or levels above the IDLH or greater than AEGL-2. It differs from Level A in that it incorporates a non-encapsulating, splash-protective, chemical-resistant splash suit that provides Level A protection against liquids but is not airtight.

Select when the contaminant and concentration of the contaminant are known and the respiratory protection criteria factors for using Air Purifying Respirators (APR) or Powered Air Purifying Respirators (PAPR) are met. This level is appropriate when decontaminating patient/victims.

Select when the contaminant and concentration of the contaminant are known and the concentration is below the appropriate occupational exposure limit or less than AEGL-1 for the stated duration times.

Effects occur rapidly following exposure to potassium cyanide. Inhalation exposure to hydrogen cyanide gas released from potassium cyanide produces symptoms within seconds to minutes; death may occur within minutes.

Early symptoms of cyanide poisoning include lightheadedness, giddiness, rapid breathing, nausea, vomiting (emesis), feeling of neck constriction and suffocation, confusion, restlessness, and anxiety. Accumulation of fluid in the lungs (pulmonary edema) may complicate severe intoxications. Rapid breathing is soon followed by respiratory depression/respiratory arrest (cessation of breathing). Severe cyanide poisonings progress to stupor, coma, muscle spasms (in which head, neck, and spine are arched backwards), convulsions (seizures), fixed and dilated pupils, and death. The CNS is the most sensitive target organ of cyanide poisoning. Cardiovascular effects require higher cyanide doses than those necessary for CNS effects. In serious poisonings, the skin is cold, clammy, and diaphoretic. Blue discoloration of the skin may be a late finding. Severe signs of oxygen deprivation in the absence of blue discoloration of the skin suggest cyanide poisoning.

The purpose of decontamination is to make an individual and/or their equipment safe by physically removing toxic substances quickly and effectively. Care should be taken during decontamination, because absorbed agent can be released from clothing and skin as a gas. Your Incident Commander will provide you with decontaminants specific for the agent released or the agent believed to have been released.

Amyl nitrite, sodium nitrite, and sodium thiosulfate are antidotes for cyanide toxicity; however, amyl nitrite and sodium nitrite should not be administered to patient/victims suffering from smoke inhalation. In these cases, only administer sodium thiosulfate. The described administration of nitrites is based on a patient having normal hemoglobin levels. Below normal hemoglobin levels require titration of nitrites.
For mild to moderate physical findings such as nausea, vomiting, palpitations, confusion, anxiety, dizziness (vertigo), and/or abnormally fast or deep respiration (hyperventilation):

Evidence for the benefit of gastric decontamination in cases of cyanide ingestion is limited at best and should come after all other known life-saving measures have been instituted. Gastric lavage (stomach pumping) is recommended only if it can be done shortly after ingestion (generally within 1 hour), in an emergency department, and after the airway has been secured. Activated charcoal may be administered as a slurry (240 mL water/30 g charcoal). Usual dose: 25 to 100 g in adults/adolescents, 25 to 50 g in children (1 to 12 years), and 1 g/kg in infants less than 1 year old. Patient/victims who have ingested hydrogen cyanide solutions or patient/victims who have direct skin or eye contact should be observed in the Emergency Department for at least 4 to 6 hours for the development of delayed symptoms. Patient/victims with significant inhalation exposure should be monitored for the accumulation of fluid in the lungs (pulmonary edema), which may occur up to 24 to 72 hours following exposure.

Usually death occurs rapidly or there is prompt recovery. Survivors of severe cyanide exposures may suffer brain damage due to a direct effect of the poison (toxin) on nerve cells, or to a lack of oxygen, or possibly due to insufficient blood circulation. Examples of long-term neurological effects caused by cyanide poisoning include personality changes, memory loss, and disturbances in movement (both voluntary and involuntary movement disorders); some damage may be permanent.

IMPORTANT NOTE: Interim AEGLs are established following review and consideration by the National Advisory Committee for AEGLs (NAC/AEGL) of public comments on Proposed AEGLs. Interim AEGLs are available for use by organizations while awaiting NRC/NAS peer review and publication of Final AEGLs. Changes to Interim values and Technical Support Documents may occur prior to publication of Final AEGL values. In some cases, revised Interim values may be posted on this Web site, but the revised Interim Technical Support Document for the chemical may be subject to change. (Further information is available through AEGL Process).

In the event of a poison emergency, call the poison center immediately at 1-800-222-1222. If the person who is poisoned cannot wake up, has a hard time breathing, or has convulsions, call 911 emergency services.

Potassium iodide (KI) is an inorganic compound that is available from three manufacturers under different brand names as an antidote to radiation exposure. From a chemistry point of view, it is made from potassium hydroxide and iodine, and it is the most produced iodide compound in the world. It is preferred over sodium iodide salt because it is less hygroscopic and easier to handle; it is an odorless and stable white crystalline powder. Among its other applications, it is used in the photography industry to form silver iodide and in chemical laboratories as a source of iodide in organic synthesis. KI is also used in biomedical research as a fluorescence quencher through its iodide ion. Upon extended exposure to air, KI becomes yellow as a result of the liberation of iodine, and small quantities of iodate may be formed due to oxidation.1

Although KI has several medical and nutritional applications, its most important application is as an antidote to radiation. Recently, KI has been in high demand in the United States due to the warning about remote radiation exposure from the recent Japanese nuclear plant radioactive releases.2 For medical purposes, a saturated solution of KI is used to treat lung congestion (as an expectorant) and sporotrichosis (a fungal infection) and as an antiseptic in sore throats.

KI's value as a radiation protective or antithyroid agent was demonstrated at the time of the Chernobyl nuclear accident when Russian authorities distributed KI in a 30-km zone around the plant. The purpose was to protect residents from the radioactive iodine, the most abundant and highly carcinogenic material found in nuclear reactors, that had been released by the damaged reactors.2,3

KI is supplied as 130-mg tablets for emergency purposes. It may also be administered as a viscous saturated solution of potassium iodide (SSKI). This formulation provides 250 mg of iodide per each five drops. According to the USP, each two drops of this solution (containing 100 mg of iodide) have the same amount of iodide as a 130-mg tablet of KI (130 mg = 100 mg iodide).2

KI was approved by the FDA in 1982 to protect the thyroid gland from radioactive iodine released accidentally from nuclear power plants or during a nuclear attack. In these events, many radionuclide products may be discharged to the atmosphere. Of these products, I131 is one of the most common, and it is particularly dangerous to the thyroid gland.1

By saturating the body with a source of stable iodide such as KI prior to exposure, inhaled or ingested I131 will be excreted from the body, and as a result, radioiodine uptake by the thyroid gland will not take place. The protective effect of KI lasts approximately 24 hours. For optimal prophylaxis, KI must be dosed daily until the risk of significant exposure to radioiodine by either inhalation or ingestion no longer exists.

Doses of 130 mg KI provide 100 mg iodide, which is roughly 700 times greater than the normal nutritional need for iodine of 150 mcg (0.15 mg, as iodide) per day for an adult. The KI in iodized salt is insufficient for this use, as 80 tablespoons would be needed to equal one tablet. See TABLE 1 for the recommended FDA dosing regimen for humans.2 KI cannot protect against any other causes of radiation poisoning or against radionuclide other than radioisotopes of iodine.

Dosing Equivalency: For protection of the thyroid against I131 contamination, the convenient standard 130-mg KI pill is used, if available. As noted, the equivalent two drops of SSKI may be used for this purpose if the pills are not available.