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Cyanide Antidotes


Cyanide Antidote Kit


Cyanide antidote kit
  • Each Cyanide Antidote Kit contains:
    • 2 Ampules Sodium Nitrite Injection (300 mg in10mL of water)
    • 2 Vials Sodium Thiosulfate Injection (12.5 g in 50mL of water)
    • 12 Ampules Amyl Nitrite Inhalants (0.3 mL)
    • 1 Sterile 10mL Disposable Syringe
    • 1 Sterile 60mL Disposable Syringe
    • 1 Sterile Disposable 20g Needle
    • 1 Stomach Tube
    • 1 Non-Sterile 60mL Syringe
    • 1 Tourniquet & Instructions for Treatment
  • Antidote Administration
    1. Break and ampule of amyl nitrite in a handkerchief and hold it in front of the patients mouth/nose. Amyl nitrite should be given in alternate intervals of 15 sec followed by 15 sec rest, using a new ampule every 3 minutes. Reapply until sodium nitrite can be administered (IV must be in place).
    2. Once the IV line is in place, amyl nitrite should be discontinued and 10 mL of 3% sodium nitrite (300mg) should be infused IV at a rate of 2.5 - 5.0 mL/min (2-4 mins). A single dose of sodium nitrite is typically enough to raise methemoglobin levels to 20% in an adult. If needed, a second dose of up to half the previous dose may be given, as long as methemoglobin levels are kept below 35-40%.
    3. Sodium thiosulfate should be given IV immediately following sodium nitrite administration at a dose of 12.5 g. If needed, a second dose (half of the initial dose) may be administered.


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Cyanokit® (Hydroxocobalamin)


Cyanokit
  • Each Cyanokit® carton (NDC 49502-550-2) consists of the following:
    • Two 250 mL glass vials, each containing lyophilized hydroxocobalamin for injection, 2.5 g
    • Two sterile transfer spikes
    • One sterile IV infusion set
    • One quick use reference guide
  • Diluent is not included
  • Antidote Administration
    1. The starting dose of Cyanokit for adults is 5 g, (two 2.5 g vials) administered by IV infusion over 15 minutes.
    2. Depending upon the severity of the poisoning and the clinical response, a second dose of 5 g may be administered by IV infusion for a total dose of 10 g.
    3. The rate of infusion for the second 5 g dose may range from 15 minutes (for patients in extremis) to 2 hours based on patient condition.
    4. The recommended diluent is 0.9% Sodium Chloride injection

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References

  1. FDA approved labels/package inserts of Cyanokit (DailyMed, NLM)