Cyanide Antidote Kit (Lily Kit)

Cyanide Antidote Kit (Lily Kit) Functional Class

Amyl Nitrite: Nitrate
Sodium Nitrite: Nitrate
Sodium Thiosulfate: Sequestrant

Cyanide Antidote Kit (Lily Kit) Mechanism of Action

Cyanide (CN) binds to iron (Fe) in the mitochondria disrupting their ability to enter the citric acid cycle associated with aerobic metabolism and thus the cell does not produce an adequate amount of ATP. Amyl nitrite and sodium nitrite oxidize the Fe in hemoglobin creating methemoglobin, which is unable to bind to oxygen. CN then is able to bind to the methemoglobin instead of the Fe in the mitochondria creating cyanmethemoglobin. Sodium thiosulfate then converts the cyanmethemoglobin into thiocyanate, sulfite, and hemoglobin. The thiocyanate and sulfite are then excreted.

Cyanide Antidote Kit (Lily Kit) Indications

Cyanide Poisoning

Cyanide Antidote Kit (Lily Kit) Contraindications

None

Cyanide Antidote Kit (Lily Kit) Precautions/Warnings

Hypotension

Cyanide Antidote Kit (Lily Kit) Adverse Reactions

Nitrate: Hypotension
Sodium Thiosulfate: Nausea, vomiting, tinnitus, muscle cramps

Cyanide Antidote Kit (Lily Kit) Drug Interactions

None in the emergency setting

Cyanide Antidote Kit (Lily Kit) Adult Dosage and Route

Amyl Nitrite: Inhalation from crushed ampule until IV is established
Sodium Nitrite: 300 mg slow IVP over 5 minutes
Sodium Thiosulfate: 12.5 g IV infused over 15 minutes

If symptoms persist after 20 minutes administer:
Sodium Nitrite: 150 mg slow IVP over 5 minutes
Sodium Thiosulfate: 62.5 g IV infused over 15 minutes

Cyanide Antidote Kit (Lily Kit) Pharmacokinetics

Limited availability