Nitroprusside and Cyanide Toxicity – Part 2
Toxicity from sodium nitroprusside is a result of the cyanide groups that are released during metabolism of the nitroprusside molecule. After gaining an electron from the iron moiety of hemoglobin, the sodium nitroprusside produces an unstable radical and hemoglobin.
The unstable nitroprusside radical produces five cyanide ions, which can have one of three end results. They can interact with methemoglobin to produce cyanomethemoglobin. They can produce thiosulfate and its end product thiocyanate. Lastly, the cyanide ions can bind cytochrome oxidase and ultimately inhibit oxidative metabolism, leading to cyanide toxicity. Organs most susceptible to the effects of the loss of oxidative metabolism are the brain and the heart.
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