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Prussian Blue

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Critical Care Toxicology

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Abstract

Prussian blue (PB) is an antidote used to treat patients with confirmed or suspected internal contamination with radioactive cesium (137Cs), radioactive thallium (201Tl), or nonradioactive thallium. PB was introduced as an antidote in the USA for drug preparedness over concerns of the possibility of bioterrorism (e.g., radiologic dispersing device or “dirty bomb”) and other radiation event. The dosing for adolescents over 12 years old and adults is 3 g taken orally three times daily. In critically ill patients who cannot swallow the capsules, these may be opened and administered by orogastric or nasogastric tube. PB should be used with caution in patients with a history of gastrointestinal obstruction, peptic ulcer disease, preexisting cardiac arrhythmias, or electrolyte imbalances.

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References

  1. Altagracia-Martinez M, Kravzov J, Martínez N, Ríos C, López N. Prussian blue as an antidote for radioactive thallium and cesium poisoning. Orphan Drugs Res Rev. 2012:2;13–21.

    Google Scholar 

  2. Thompson DF, Callen ED. Soluble or insoluble Prussian blue for radiocesium and thallium poisoning? Ann Pharmacother. 2004;38(9):1509–14.

    Article  CAS  PubMed  Google Scholar 

  3. Prussian Blue (ferric hexacyanoferrate (II)) for treatment of internal contamination with thallium or radioactive cesium. U.S. Food and Drug Administration; 2003 [updated 2012 Dec 11, cited 2015 Aug 27]. Available from: http://www.fda.gov/Drugs/EmergencyPreparedness/BioterrorismandDrugPreparedness/ucm130334.htm

  4. National Council on Radiation Protection and Measurements, Knovel (Firm). Management of persons contaminated with radionuclides handbook: recommendations of the National Council on Radiation Protection and Measurements. Bethesda: National Council on Radiation Protection and Measurements; 2009 [cited 2015 Aug 27]. Available from: http://app.knovel.com/web/toc.v/cid:kpMPCRHRN1

  5. Dart RC, Borron SW, Caravati EM, Cobaugh DJ, Curry SC, Falk JL, et al. Expert consensus guidelines for stocking of antidotes in hospitals that provide emergency care. Ann Emerg Med. 2009;54(3):386–94.

    Article  PubMed  Google Scholar 

  6. Moore BL, Geller RJ, Clark C. Hospital preparedness for chemical and radiological disasters. Emerg Med Clin North Am. 2015;33(1):37–49.

    Article  PubMed  Google Scholar 

  7. Office of Public Health Preparedness and Response. Strategic National Stockpile (SNS). Atlanta: Centers for Disease Control and Prevention; 2015 [updated 2015 Oct 4; cited 2015 July 27]. Available from: http://www.cdc.gov/phpr/stockpile/stockpile.htm

  8. van der Merwe CF. The treatment of thallium poisoning. A report of 2 cases. S Afr Med J. 1972;46(28):560–1.

    PubMed  Google Scholar 

  9. Stevens W, van Peteghem C, Heyndrickx A, Barbier F. Eleven cases of thallium intoxication treated with Prussian blue. Int J Clin Pharmacol. 1974;10(1):1–22.

    CAS  PubMed  Google Scholar 

  10. Pedersen RS, Olesen AS, Freund LG, Solgaard P, Larsen E. Thallium intoxication treated with long-term hemodialysis, forced diuresis and Prussian blue. Acta Med Scand. 1978;204(5):429–32.

    CAS  PubMed  Google Scholar 

  11. Ghezzi R, Bozza MM. Prussian blue in the treatment of thallium intoxication. Vet Hum Toxicol. 1979;21(Suppl):64–6.

    PubMed  Google Scholar 

  12. De Backer W, Zachee P, Verpooten GA, Majelyne W, Vanheule A, De Broe ME. Thallium intoxication treated with combined hemoperfusion-hemodialysis. J Toxicol Clin Toxicol. 1982;19(3):259–64.

    Article  PubMed  Google Scholar 

  13. Pai V. Acute thallium poisoning. Prussian blue therapy in 9 cases. West Indian Med J. 1987;36(4):256–8.

    CAS  PubMed  Google Scholar 

  14. Wainwright AP, Kox WJ, House IM, Henry JA, Heaton R, Seed WA. Clinical features and therapy of acute thallium poisoning. Q J Med. 1988;69(259):939–44.

    CAS  PubMed  Google Scholar 

  15. Chandler HA, Archbold GP, Gibson JM, O'Callaghan P, Marks JN, Pethybridge RJ. Excretion of a toxic dose of thallium. Clin Chem. 1990;36(8 Pt 1):1506–9.

    CAS  PubMed  Google Scholar 

  16. Diaz V, Tapia R, Brinck G, Gutierrez M, Hurtado C, del Peso G. Thallium poisoning: Prussian blue treatment in 4 cases. Rev Med Chil. 1990;118(2):183–5.

    CAS  PubMed  Google Scholar 

  17. Rangel-Guerra R, Martinez HR, Villarreal HJ. Thallium poisoning. Experience with 50 patients. Gac Med Mex. 1990;126(6):487–94, discussion 94–5.

    CAS  PubMed  Google Scholar 

  18. Vergauwe PL, Knockaert DC, Van Tittelboom TJ. Near fatal subacute thallium poisoning necessitating prolonged mechanical ventilation. Am J Emerg Med. 1990;8(6):548–50.

    Article  CAS  PubMed  Google Scholar 

  19. Atsmon J, Taliansky E, Landau M, Neufeld MY. Thallium poisoning in Israel. Am J Med Sci. 2000;320(5):327–30.

    Article  CAS  PubMed  Google Scholar 

  20. Miller MA, Patel MM, Coon T. Prussian blue for treatment of thallium overdose in the US. Hosp Pharm. 2005;40(9):796–7.

    Google Scholar 

  21. Centers for Disease Control and Prevention (CDC). Thallium poisoning from eating contaminated cake – Iraq, 2008. MMWR Morb Mortal Wkly Rep. 2008;57(37):1015–8.

    Google Scholar 

  22. Pelclova D, Urban P, Ridzon P, Senholdova Z, Lukas E, Diblik P, et al. Two-year follow-up of two patients after severe thallium intoxication. Hum Exp Toxicol. 2009;28(5):263–72.

    Article  CAS  PubMed  Google Scholar 

  23. Al Hammouri F, Darwazeh G, Said A, Ghosh RA. Acute thallium poisoning: series of ten cases. J Med Toxicol. 2011;7(4):306–11.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Pelclova D, Farna H, Vlckova S, Caganova B, Plackova S, Zakharov S. International co-operation in treatment of suicidal thallium intoxication. Clin Toxicol. 2012;50(4):300.

    Article  Google Scholar 

  25. Sun TW, Xu QY, Zhang XJ, Wu Q, Liu ZS, Kan QC, et al. Management of thallium poisoning in patients with delayed hospital admission. Clin Toxicol. 2012;50(1):65–9.

    Article  Google Scholar 

  26. Apostolova D, Atanasov V, Ganeva SH, Stoyneva Z, Stankova E, Toncheva R, et al. XXXIII International Congress of the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) 28–31 May 2013, Copenhagen, Denmark. Clin Toxicol. 2013;51(4):252–378.

    Article  Google Scholar 

  27. Riyaz R, Pandalai SL, Schwartz M, Kazzi ZN. A fatal case of thallium toxicity: challenges in management. J Med Toxicol. 2013;9(1):75–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Li JM, Wang W, Lei S, Zhao LL, Zhou D, Xiong H. Misdiagnosis and long-term outcome of 13 patients with acute thallium poisoning in China. Clin Toxicol (Phila). 2014;52(3):181–6.

    Article  CAS  Google Scholar 

  29. Farina R, Brandao-Mello CE, Oliveira AR. Medical aspects of 137Cs decorporation: the Goiania radiological accident. Health Phys. 1991;60(1):63–6.

    Article  CAS  PubMed  Google Scholar 

  30. Lipsztein JL, Bertelli L, Oliveira CA, Dantas BM. Studies of Cs retention in the human body related to body parameters and Prussian blue administration. Health Phys. 1991;60(1):57–61.

    Article  CAS  PubMed  Google Scholar 

  31. Oliveira AR, Hunt JG, Valverde NJ, Brandao-Mello CE, Farina R. Medical and related aspects of the Goiania accident: an overview. Health Phys. 1991;60(1):17–24.

    Article  CAS  PubMed  Google Scholar 

  32. Ming-hua T, Yi-fen G, Cheng-yao S, Chang-qing Y, De-chang W. Measurement of internal contamination with radioactive caesium released from the Chernobyl accident and enhanced elimination by Prussian blue. J Radiol Prot. 1988;8(1):25–8.

    Article  Google Scholar 

  33. Chan CK, Chan MH, Tse ML, Chan IH, Cheung RC, Lam CW, et al. Life-threatening Torsades de Pointes resulting from “natural” cancer treatment. Clin Toxicol. 2009;47(6):592–4.

    Article  CAS  Google Scholar 

  34. Thurgur L, Singh D, Thomspon M. Non-radioactive cesium toxicity: a case of treatment using Prussian Blue [abstract]. Clin Toxicol. 2006;44:730.

    Google Scholar 

  35. Product monograph: radiogardase. 2014 [updated 2014 Aug; cited 2015 Aug 27] Available from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/021626s010lbl.pdf

  36. Faustino PJ, Yang Y, Progar JJ, Brownell CR, Sadrieh N, May JC, et al. Quantitative determination of cesium binding to ferric hexacyanoferrate: Prussian blue. J Pharm Biomed Anal. 2008;47(1):114–25.

    Article  CAS  PubMed  Google Scholar 

  37. Verzijl JM, Joore JC, van Dijk A, Glerum JH, Savelkoul TJ, Sangster B, et al. In vitro binding characteristics for cesium of two qualities of Prussian blue, activated charcoal and Resonium-A. J Toxicol Clin Toxicol. 1993;30(2):215–22.

    Article  Google Scholar 

  38. Yang Y, Faustino PJ, Progar JJ, Brownell CR, Sadrieh N, May JC, et al. Quantitative determination of thallium binding to ferric hexacyanoferrate: Prussian blue. Int J Pharm. 2008;353(1-2):187–94.

    Article  CAS  PubMed  Google Scholar 

  39. Hoffman RS, Stringer JA, Feinberg RS, Goldfrank LR. Comparative efficacy of thallium adsorption by activated charcoal, Prussian blue, and sodium polystyrene sulfonate. J Toxicol Clin Toxicol. 1999;37(7):833–7.

    Article  CAS  PubMed  Google Scholar 

  40. Lehmann PA, Favari L. Parameters for the adsorption of thallium ions by activated charcoal and Prussian blue. J Toxicol Clin Toxicol. 1984;22(4):331–9.

    Article  CAS  PubMed  Google Scholar 

  41. Hoffman RS. Thallium toxicity and the role of Prussian blue in therapy. Toxicol Rev. 2003;22(1):29–40.

    Article  CAS  PubMed  Google Scholar 

  42. Nielsen P, Dresow B, Fischer R, Heinrich HC. Bioavailability of iron and cyanide from oral potassium ferric hexacyanoferrate(II) in humans. Arch Toxicol. 1990;64(5):420–2.

    Article  CAS  PubMed  Google Scholar 

  43. Giese WW. Ammonium-ferric-cyano-ferrate(II) (AFCF) as an effective antidote against radiocaesium burdens in domestic animals and animal derived foods. Br Vet J. 1988;144(4):363–9.

    Article  CAS  PubMed  Google Scholar 

  44. Yang Y, Brownell C, Sadrieh N, May J, Del A. Quantitative measurement of cyanide released from Prussian blue. Clin Toxicol. 2007;45(7):776–81.

    Article  CAS  Google Scholar 

  45. Thompson DF. Management of thallium poisoning. Clin Toxicol. 1981;18(8):979–90.

    Article  CAS  PubMed  Google Scholar 

  46. Verzijl JM, Joore HC, van Dijk A, Wierckx FC, Savelkoul TJ, Glerum JH. In vitro cyanide release of four Prussian blue salts used for the treatment of cesium contaminated persons. J Toxicol Clin Toxicol. 1993;31(4):553–62.

    Article  CAS  PubMed  Google Scholar 

  47. Bailey B. Are there teratogenic risks associated with antidotes used in the acute management of poisoned pregnant women? Birth defects research Part A. Clin Mol Teratol. 2003;67(2):133–40.

    Article  CAS  Google Scholar 

  48. Bhardwaj N, Bhatnagar A, Pathak DP, Singh AK. Dynamic, equilibrium and human studies of adsorption of 201Tl by Prussian blue. Health Phys. 2006;90(3):250–7.

    Article  CAS  PubMed  Google Scholar 

  49. BARDA awards contract to develop Prussian blue for pediatric use – contract supports advanced development of Prussian blue for infants ages newborn to two years. HHS News [Internet]. 2011 [cited 2015 Aug 27]. Available from: http://www.phe.gov/Preparedness/news/Pages/prussianblue.aspx

  50. Public meeting – August 8, 2014. National Advisory Committee on Children and Disasters [Internet]. 2014 [cited 2015 Aug 27]. Available from: http://www.phe.gov/Preparedness/legal/boards/naccd/meetings/Documents/naccd_publicmtg_transcript08082014.pdf

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Author information

Authors and Affiliations

  1. Department of Environmental Health and Toxicology, Institut national de santé publique du Québec, Québec, QC, Canada

    Pierre-André Dubé

  2. Faculty of Pharmacy, Université Laval, Québec, QC, Canada

    Pierre-André Dubé

  3. Department of Medicine, Emergency Medicine, McGill University Health Centre, Montreal, QC, Canada

    Sophie Gosselin

Authors
  1. Pierre-André Dubé
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  2. Sophie Gosselin
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Corresponding author

Correspondence to Pierre-André Dubé .

Editor information

Editors and Affiliations

  1. University of Colorado School of Medicine, Toxicology Associates, Denver, Colorado, USA

    Jeffrey Brent

  2. Office of New Drugs Drug Evaluation and Research, FDA, Silver Spring, Maryland, USA

    Keith Burkhart

  3. Clinical Toxicology, St Thomas' Hospital, London, United Kingdom

    Paul Dargan

  4. University of Colorado School of Medicine, Toxicology Associates, Denver, Colorado, USA

    Benjamin Hatten

  5. Med & Toxicological Intensive Care Unit, Lariboisière Hospital Paris-Diderot University, Paris, France

    Bruno Megarbane

  6. University of Colorado School of Medicine, Toxicology Associates, Denver, Colorado, USA

    Robert Palmer

Grading System for Levels of Evidence Supporting Recommendations in Critical Care Toxicology, 2nd Edition

  1. I.

    Evidence obtained from at least one properly randomized controlled trial.

  2. II-1

    Evidence obtained from well-designed controlled trials without randomization.

  3. II-2

    Evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group.

  4. II-3

    Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of the introduction of penicillin treatment in the 1940s) could also be regarded as this type of evidence.

  5. III

    Opinions of respected authorities, based on clinical experience, descriptive studies, and case reports, or reports of expert committees.

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Dubé, PA., Gosselin, S. (2016). Prussian Blue. In: Brent, J., Burkhart, K., Dargan, P., Hatten, B., Megarbane, B., Palmer, R. (eds) Critical Care Toxicology. Springer, Cham. https://doi.org/10.1007/978-3-319-20790-2_167-1

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  • DOI: https://doi.org/10.1007/978-3-319-20790-2_167-1

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  • Publisher Name: Springer, Cham

  • Online ISBN: 978-3-319-20790-2

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