EMS Medication: Cyanide Antidote Kit

Trade Name and Classification

Cyanide Antidote Kit

Trade Name: Cyanide Antidote Package

Class: Antidote

Desired Effects

Speeds breakdown and degradation of cyanide, a potent cellular toxin.

Mechanism of Action

A water soluble salt and reducing agent that reacts with oxidizing agents.

Although its exact mechanism of action is unknown, thiosulfate likely provides an exogenous source of sulfur, thereby hastening the detoxification of cyanide through the enzyme rhodanese (thiosulfate cyanide sulfurtransferase) which converts cyanide to the relatively nontoxic, excretable thiocyanate ion.

Indications

Known or highly suspected significant cyanide ingestion or poisoning

Contraindications

Significant allergy to thiosulfate or nitrate

Adverse Reactions

Hypotension

Nausea and vomiting

Drug Interactions

Diazoxide may enhance the hypotensive effect of Antihypertensives

Precautions

Smoke inhalation: Use nitrites cautiously in patients with cyanide poisoning related to smoke inhalation because methemoglobinemia and carboxyhemoglobinemia may worsen oxygen-carrying capacity.

Special Considerations

Amyl Nitrate ampules should be administered 30 seconds at a time alternating between ampules and 100% oxygen.

Dosing Regimen

Adult:

• Amyl Nitrate - inhalation

• Sodium Nitrate - 10ml IVP over 3 minutes

• Sodium Thiosulfate - 50ml IVP over 10 minutes

Pediatric:

• Amyl Nitrate - inhalation

• Sodium Nitrate - 0.2 ml/kg IVP over 3 minutes

• Sodium Thiosulfate - 0.8 ml/kg IVP over 10 minutes

Protocol Location

Toxic Exposure - Cyanide Exposure