In 1932 Geiger1 began to use methylene blue in treatment of cyanide poisoning. The antidotal action of the dye was shown by Wendel2 and Hug3 to be due to the formation of methemoglobin, which successfully competes with the respiratory enzyme, ferricytochrome oxidase, for cyanide ions. Subsequent reports4 indicate that methylene blue is not an efficient antidote because it is a poor methemoglobin former and at the same time reverses the reaction in presence of co-enzyme.5 In fact, the dye is of greater value in the treatment of methemoglobinemia6 than in cyanide poisoning. Nevertheless, the trial of methylene blue stimulated a renewed search for cyanide antidotes, and led to the discovery of a more effective therapy.
Independent investigations in Argentina7 and the United States4a gave rise to a clear-cut conclusion that the combination of sodium nitrite and sodium thiosulfate, consecutively injected by vein,
Chen KK, Rose CL. NITRITE AND THIOSULFATE THERAPY IN CYANIDE POISONING. JAMA. 1952;149(2):113–119. doi:10.1001/jama.1952.02930190015004
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