(Optional medication – not required for every BioTel agency)
Indications: Cyanide toxicity
Contraindications:
Absolute: None
Relative: History of anaphylactic reaction to hydroxocobalamin or cyanocobalamin
Precautions:
Pregnancy: Category C
Lactation: Excretion in milk unknown – use with caution
Co-administration with other cyanide antidotes – use with caution
Side Effects:
Flushing, urticaria, itching or rash
Chest tightness and dyspnea
Transient blood pressure elevation
Anaphylaxis
Red skin, tears, sweat and urine
Adult Dose:
Standing order for Cyanide toxicity:
5 grams (2 vials) over 15 minutes:
- Reconstitute EACH 2.5 g vial in 100 mL Normal Saline
- Invert or rock the vial for 30 seconds – do NOT shake
- Final concentration: 25 mg/mL
- Lactated Ringers solution may be substituted, if Normal Saline is unavailable
- Administer total 5 g dose over 15 minutes (approximately 15 mL/minute)
- May repeat once if the patient is still symptomatic after 30 minutes
- Total maximum, cumulative dose: 10 g
Pediatric Dose:
Standing order for Cyanide toxicity:
70 mg/kg (~3 mL/kg) over 15 minutes:
- Reconstitute EACH 2.5 g vial in 100 mL Normal Saline
- Invert or rock the vial for 30 seconds – do NOT shake
- Final concentration: 25 mg/mL
- Lactated Ringers solution may be substituted, if Normal Saline is unavailable
- Administer 70 mg/kg (~3 mL/kg) over 15 minutes
- May repeat once at half the dose (35 mg/kg) (~1.5 mL/kg) if the patient is still symptomatic after 30 minutes
- Total maximum, cumulative dose: 10 g
How Supplied: Two vials, 2.5 grams each, per Cyanokit. Normal Saline diluent is NOT included in the kit
Route: IV or IO
Drug Action: Vitamin B12 molecule complexed to cobalt: cyanide displaces the cobalt on the molecule, resulting in cyanocobalamin, which is then removed from the body by renal excretion
Class: Cyanide antidote
Onset: Rapid
Duration: Several hours