Usual Adult Dose for Cyanide Poisoning

50 mL, slow IV, immediately after sodium nitrite infusion

Comments:

• Use concomitantly with sodium nitrite.
• Administer as soon as possible after diagnosis of life-threatening cyanide poisoning.
• If suspicion of cyanide poisoning is high, initiate treatment without delay.
• Use as an adjunct to supportive therapies
• When the diagnosis of cyanide poisoning is uncertain, carefully weigh the potential risks against the potential benefits, especially if the patient is not in extremis.

Usual Pediatric Dose for Cyanide Poisoning

1 mL/kg (30 to 40 mL/m(2)), slow IV, immediately after sodium nitrite infusion
Maximum dose: 50 mL

Comments:

• Use concomitantly with sodium nitrite.
• Administer as soon as possible after diagnosis of life-threatening cyanide poisoning.
• If suspicion of cyanide poisoning is high, initiate treatment without delay.
• Use as an adjunct to supportive therapies
• When the diagnosis of cyanide poisoning is uncertain, carefully weigh the potential risks against the potential benefits, especially if the patient is not in extremis.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Dose Adjustments

• If signs of poisoning reappear, repeat treatment using half the original dose.

• Reduce dose proportionally to the hemoglobin concentration.

• Decrease rate of infusion if significant hypotension is noted.

Dialysis

Data not available

Other Comments

Storage requirements:

• Store at controlled room temperature.
• Protect from direct light.
• Do not freeze.

• Not compatible with hydroxocobalamin.

• Monitor blood pressure during the infusion.
• Monitor patients at least 24 to 48 hours for adequate oxygenation, perfusion, and for signs of recurrence of cyanide toxicity.
• When possible, obtain hemoglobin/hematocrit at treatment initiation.
• Pulse oximetry and calculated oxygen saturation based on measured PO(2) are unreliable in the presence of methemoglobinemia.