Methemoglobin-forming agents are potent, but due to the transformation of hemoglobin into methemoglobin, they impair tissue delivery of oxygen. Sodium thiosulfate is both efficient and safe, but acts with delay. smoke inhalation, we should take into account not only the efficiency of antidotes but also their safety. However, regarding the main clinical condition of cyanide poisoning, i.e. Sodium thiosulfate, methemoglobin forming agents and cobalt compounds act efficiently by complexing or transforming cyanide into non-toxic stable derivatives. Oxygen counteracts efficiently cyanide action at the mitochondrial level. Supportive treatment is efficient but does not modify the time course or the body burden of cyanide. Advanced life support includes mechanical ventilation, catecholamine and sodium bicarbonate infusion. Basic life support includes immediate administration of high flow of oxygen, airway protection and cardiopulmonary resuscitation. Decontamination should be adapted to the route of poisoning and never postpone supportive treatment. Conventional treatment of cyanide poisoning includes decontamination, supportive and specific treatment. This article reviews the literature on cyanide poisoning treatment. Our objective was to compare conventional treatments to hydroxocobalamin. However, therapeutic strategies are still debated. Many antidotes are available and efficient. A plasma lactate concentration > or = 10 mmol/L in fire victims without severe burns and > or = 8 mmol/L in pure cyanide poisoned patients is a sensitive and specific indicator of cyanide intoxication. The biological hallmark is lactic acidosis. Clinical features include coma, respiratory arrest and cardiovascular collapse. Cyanide poisoning may result from different exposures: residential fires, industrial accidents, drug and plant intoxication.
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