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Prompt administration of 3% sodium nitrite is supported by a few anecdotal reports.3 Nitrites effectively induce methaemoglobinaemia and the resultant ferricheme has a greater affinity for H2S than cytochrome-coxidase, thereby freeing cytochrome-c oxidase and allowing aerobic metabolism to resume.4 The recommended dose of sodium nitrite is 0.12 to 0.33 mg/kg in children and 300 mg in adults.4 Sodium thiosulfate is used to treat cyanide toxicity, but not H2S toxicity.4 It is recommended that patient with H2S poisoning who presents with altered mental status, coma, hypotension and dysrhythmia should receive sodium nitrite.4
Furthermore, CO also binds to the proteins myoglobin and cytochrome-c oxidase, which are found in the cardiac and skeletal muscles.
Van den Bogert, "Assembly of cytochrome-c oxidase in cultured human cells," European Journal of Biochemistry, vol.
Hansikova et al., "High-resolution melting analysis of 15 genes in 60 patients with cytochrome-c oxidase deficiency," Journal of Human Genetics, vol.
Kadenbach, "Tissue-specific regulation of bovine heart cytochrome-c oxidase activity by ADP via interaction with subunit VIa," Proceedings of the National Academy of Sciences of the United States of America, vol.