Post by blueeighty8 on Jan 31, 2005 20:20:20 GMT -5
PENNSYLVANIA DEPARTMENT OF HEALTH
HEALTH ALERT #70
Date: January 30th, 2005
Subject: Probable Cyanide Intoxication in Heroin Users
To: Health Alert Network
From: Calvin B. Johnson, M.D., M.P.H. Secretary of Health
This transmission is a "Health Alert", conveys the highest level of importance; warrants immediate
action or attention
HOSPITALS: PLEASE SHARE THIS WITH ALL MEDICAL, INFECTION CONTROL, NURSING &
PHARMACY STAFF IN YOUR HOSPITAL
FQHCs: PLEASE DISTRIBUTE AS APPROPRIATE
LOCAL HEALTH JURISDICTIONS: PLEASE DISTRIBUTE AS APPROPRIATE
NURSING HOMES: PLEASE DISTRIBUTE AS APPROPRIATE
EMS COUNCILS: PLEASE DISTRIBUTE AS APPROPRIATE
PROFESSIONAL HEALTH ORGANIZATIONS: PLEASE DISTRIBUTE TO YOUR MEMBERSHIP AS
APPROPRIATE
The Pennsylvania Department of Health (PADOH), and the Philadelphia Department of Public
Health (PDPH) are releasing the following information regarding probable Cyanide intoxication in
heroin users.
The New Jersey Poison Control Center has reported seven cases of probable cyanide intoxication
in heroin users who are currently hospitalized in three different healthcare facilities in central New
Jersey.
The first case presented early on January 29, and the most recent case was admitted early on
January 30. All reported nasally insufflating heroin. One presented with a lactic acidosis and
hypotension and was found to have an elevated pVO2, the rest presented with nausea, headache,
low potassium and elevated pVO2. The venous blood specimens appeared to be arterial although 2
had blood drawn from central venous lines, confirmed by pressure and radiography. The illness is
also characterized by agitation, tachypneia, and tachycardia. Venous blood from these case patients
has the characteristic appearance of oxygenated blood.
Three of the six received thiosulfate infusions and transiently improved; they rebounded and then all
received sodium nitrite after which their pVO2 levels dropped to within the normal range. Rebound
was seen in two of the patients with pVO2 again over 100.
The source of the heroin has at this time been reported only as from dealers in Easton, PA and
Asbury Park, NJ. Laboratory confirmation of cyanide in clinical specimens is pending. Criminal and
public health investigations are in progress and the presence of cyanide has not yet been
established in heroin used by the case patients. The source of this heroin, and the extent of its
distribution are unknown at this time.
Clinicians and emergency medical responders caring for individuals with similar illness and recent
history of heroin abuse should consider cyanide intoxication, and initiate empiric therapy if their
diagnostic evaluation suggests this diagnosis.
Information about cyanide is available at www.bt.cdc.gov/agent/cyanide/basics/facts.asp <http://
www.bt.cdc.gov/agent/cyanide/basics/facts.asp>, and at www.atsdr.cdc.gov
<http://www.atsdr.cdc.gov>. Contact the Poison Control Center at 1-800-222-1222 for additional
information regarding the diagnosis or treatment of cyanide poisoning.
Veronica Urdaneta, MD, MPH
Planning and Preparedness Section Leader
Health Alert Network Coordinator
Division of Infectious Disease Epidemiology
P.O. Box 90 Room 933
Harrisburg, PA 17108
Tel: (717) 787-3350
Pager: 877-440-5117
Fax: (717) 772-6975
vurdaneta@state.pa.us
HEALTH ALERT #70
Date: January 30th, 2005
Subject: Probable Cyanide Intoxication in Heroin Users
To: Health Alert Network
From: Calvin B. Johnson, M.D., M.P.H. Secretary of Health
This transmission is a "Health Alert", conveys the highest level of importance; warrants immediate
action or attention
HOSPITALS: PLEASE SHARE THIS WITH ALL MEDICAL, INFECTION CONTROL, NURSING &
PHARMACY STAFF IN YOUR HOSPITAL
FQHCs: PLEASE DISTRIBUTE AS APPROPRIATE
LOCAL HEALTH JURISDICTIONS: PLEASE DISTRIBUTE AS APPROPRIATE
NURSING HOMES: PLEASE DISTRIBUTE AS APPROPRIATE
EMS COUNCILS: PLEASE DISTRIBUTE AS APPROPRIATE
PROFESSIONAL HEALTH ORGANIZATIONS: PLEASE DISTRIBUTE TO YOUR MEMBERSHIP AS
APPROPRIATE
The Pennsylvania Department of Health (PADOH), and the Philadelphia Department of Public
Health (PDPH) are releasing the following information regarding probable Cyanide intoxication in
heroin users.
The New Jersey Poison Control Center has reported seven cases of probable cyanide intoxication
in heroin users who are currently hospitalized in three different healthcare facilities in central New
Jersey.
The first case presented early on January 29, and the most recent case was admitted early on
January 30. All reported nasally insufflating heroin. One presented with a lactic acidosis and
hypotension and was found to have an elevated pVO2, the rest presented with nausea, headache,
low potassium and elevated pVO2. The venous blood specimens appeared to be arterial although 2
had blood drawn from central venous lines, confirmed by pressure and radiography. The illness is
also characterized by agitation, tachypneia, and tachycardia. Venous blood from these case patients
has the characteristic appearance of oxygenated blood.
Three of the six received thiosulfate infusions and transiently improved; they rebounded and then all
received sodium nitrite after which their pVO2 levels dropped to within the normal range. Rebound
was seen in two of the patients with pVO2 again over 100.
The source of the heroin has at this time been reported only as from dealers in Easton, PA and
Asbury Park, NJ. Laboratory confirmation of cyanide in clinical specimens is pending. Criminal and
public health investigations are in progress and the presence of cyanide has not yet been
established in heroin used by the case patients. The source of this heroin, and the extent of its
distribution are unknown at this time.
Clinicians and emergency medical responders caring for individuals with similar illness and recent
history of heroin abuse should consider cyanide intoxication, and initiate empiric therapy if their
diagnostic evaluation suggests this diagnosis.
Information about cyanide is available at www.bt.cdc.gov/agent/cyanide/basics/facts.asp <http://
www.bt.cdc.gov/agent/cyanide/basics/facts.asp>, and at www.atsdr.cdc.gov
<http://www.atsdr.cdc.gov>. Contact the Poison Control Center at 1-800-222-1222 for additional
information regarding the diagnosis or treatment of cyanide poisoning.
Veronica Urdaneta, MD, MPH
Planning and Preparedness Section Leader
Health Alert Network Coordinator
Division of Infectious Disease Epidemiology
P.O. Box 90 Room 933
Harrisburg, PA 17108
Tel: (717) 787-3350
Pager: 877-440-5117
Fax: (717) 772-6975
vurdaneta@state.pa.us