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Nitroprusside: Toxicity

- Discussion: 
- therapy for > 24 hrs, excessive dosage, or RF may cause acculuation of thiocyanate, the metabolite, is excreted by kidney; 
- thiocyanatetoxicity occurs at plasma levels of 5-10mg/dl; 
- look for metabolic acidosis (early sign) blurred vision, tinnitus, or delirium, hepatic dysF(x), dyspnea, V, dizziness, ataxia, and syncope; 
- metabolic acidosis is the screening sign for toxicity; 
- Treatment: 
- discontinuance and dialysis are mainstays of treatment; 
- prophylactic infusion of hydrocobalamin (25mg/hr) has been shown to decrease cyanate concentration