Summary Of Exposure |
A) WITH THERAPEUTIC USE
1) Nausea, vomiting, diaphoresis, chest pain, dysrhythmias, hypotension, rash, angioedema, tremor, collapse, and seizures have been reported. Adverse effects appear to be more common in patients who receive therapeutic doses of dicobalt EDTA who do not have cyanide poisoning.
B) WITH POISONING/EXPOSURE
1) No data available.
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Cardiovascular |
3.5.2) CLINICAL EFFECTS
A) CONDUCTION DISORDER OF THE HEART 1) WITH THERAPEUTIC USE a) Atrial fibrillation and ventricular ectopy may rarely develop, and may be secondary to calcium and magnesium chelation by EDTA after it dissociates from the cobalt (Peters et al, 1982).
B) HYPOTENSIVE EPISODE 1) WITH THERAPEUTIC USE a) Transient hypotension and tachycardia may develop shortly after dicobalt EDTA administration (Davison, 1969).
b) CASE REPORT - An adult male developed hypotension, palpitations, and edema of the face and neck after receiving dicobalt EDTA for suspected cyanide exposure (Tyrer, 1981). It was later felt that this patient probably did not have cyanide poisoning.
C) CHEST PAIN 1) WITH THERAPEUTIC USE a) CASE REPORT - An adult male collapsed and then developed chest pain and shortness of breath after receiving a dose of dicobalt EDTA for suspected cyanide poisoning. A second dose of dicobalt EDTA was then administered, after which he felt much worse. It was later felt that this patient probably never had cyanide poisoning (only symptoms prior to dicobalt EDTA were faintness and breathlessness) (Tyrer, 1981).
3.5.3) ANIMAL EFFECTS
A) ANIMAL STUDIES 1) Dogs treated with 10.5 mg/kg dicobalt EDTA developed marked increases in heart rate and cardiac output and decreases in systemic vascular resistance while blood pressure was maintained. These changes were associated with an increase in plasma epinephrine and norepinephrine concentrations (Riou et al, 1993).
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Respiratory |
3.6.2) CLINICAL EFFECTS
A) EDEMA OF LARYNX 1) WITH THERAPEUTIC USE a) CASE REPORT - A 43-year-old man was immersed in a vat of hot cupric cyanide, became unconscious and cyanotic with irregular respirations. He was treated with oxygen and two 300 mg doses of dicobalt EDTA. Shortly thereafter he rapidly developed periorbital edema. Intubation was also needed, and early laryngeal edema was noted on laryngoscopy. On repeat laryngoscopy (60 seconds later), there was severe laryngeal edema obscuring the cords and epiglottis. He then developed severe facial edema and pulmonary edema. He ultimately recovered with intensive supportive care (including administration of amyl nitrate, sodium thiosulfate and sodium nitrate). The authors felt that the facial and laryngeal edema ware likely secondary to the dicobalt EDTA (Dodds & McKnight, 1985).
b) CASE REPORT - A 6-year-old girl developed facial and laryngeal edema shortly after receiving dicobalt EDTA for suspected cyanide poisoning. She recovered with supportive care (Brian, 1990).
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Neurologic |
3.7.2) CLINICAL EFFECTS
A) SEIZURE 1) WITH THERAPEUTIC USE a) An adult male developed seizures after receiving dicobalt EDTA to treat suspected cyanide exposure. It was later felt that this patient never had cyanide poisoning (Tyrer, 1981).
B) COLLAPSE 1) WITH THERAPEUTIC USE a) Two men collapsed after receiving dicobalt EDTA for suspected cyanide exposure. It was later felt that neither patient had cyanide poisoning (Tyrer, 1981).
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Gastrointestinal |
3.8.2) CLINICAL EFFECTS
A) NAUSEA AND VOMITING 1) WITH THERAPEUTIC USE a) Nausea and vomiting may develop shortly after dicobalt EDTA administration (Davison, 1969).
3.8.3) ANIMAL EFFECTS
A) ANIMAL STUDIES 1) Dogs treated with 10.5 mg/kg dicobalt EDTA developed vomiting (Riou et al, 1993).
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Dermatologic |
3.14.2) CLINICAL EFFECTS
A) URTICARIA 1) WITH THERAPEUTIC USE a) Urticaria is a fairly common reaction, which can develop shortly after dicobalt EDTA administration (Tyrer, 1981; Froneman, 1975).
B) EXCESSIVE SWEATING 1) WITH THERAPEUTIC USE a) CASE REPORT - An adult male developed agitation and diaphoresis after receiving dicobalt EDTA about 24 hours after cyanide exposure (Melloni et al, 1983).
C) ANGIOEDEMA 1) WITH THERAPEUTIC USE a) Angioedema is fairly common after dicobalt EDTA administration, occasionally life threatening upper airway edema develops (Brian, 1990; Dodds & McKnight, 1985).
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Immunologic |
3.19.2) CLINICAL EFFECTS
A) ANAPHYLACTOID REACTION 1) WITH THERAPEUTIC USE a) Anaphylactoid reactions (urticaria, angioedema, hypotension, laryngeal edema) have developed immediately after dicobalt EDTA administration. These reactions have occurred both in patients with clear clinical manifestations of cyanide poisoning (Wright & Vesey, 1986), and in patients with a history of working with cyanide who were treated with dicobalt EDTA, but who never had clinical manifestations of cyanide poisoning (Tyrer, 1981).
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Reproductive |
3.20.1) SUMMARY
A) There are no case reports of use in pregnancy, or reliable animal teratogenicity data.
B) There are no case reports of use in pregnancy, or reliable animal teratogenicity data (Prod Info KELOCYANOR IV solution for injection, 1997).
3.20.4) EFFECTS DURING BREAST-FEEDING
A) LACK OF INFORMATION 1) There is no information on the excretion of dicobalt EDTA into breast milk. Breast feeding should be avoided while dicobalt EDTA is being used (Prod Info KELOCYANOR IV solution for injection, 1997).
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