cyanide antidote pack

Indications

antidote to cyanide poisoning

Dosage

• 1st sodium nitrite 300 mg (10 mL) IV
• 2nd sodium thiosulfate 12.5 grams (50 mL) by slow IV push
  • repeat with 1/2 the dose as needed
• 3rd amyl nitrite: inhale 1-6 times using 0.3 mL inhalants
  • repeat every 3-5 minutes as needed

Kit contains:

• sodium nitrite 300 mg/10 mL ampules
• sodium thiosulfate 12.5 grams/50 mL ampules
• amyl nitrite 0.3 mL ampules
• stomach tube
• syringes & needles

Pharmacokinetics

• sodium thiosulfate
  • distributes to extracellular fluid
  • 1/2life 30-40 minutes
  • excreted unchange in the urine
• amyl nitrite inhalation:
  • onset of action 30 seconds
  • duration of action 3-5 minutes

Adverse effects

• tachycardia
• hypotension
• dizziness
• headache
• skin flushing
• palpitations
• nausea
• diarrhea

Mechanism of action

• sodium thiosulfate used with sodium nitrite increases cyanide detoxification by sulfur donation to rhodanese, with conversion of cyanide to non-toxic thiocyanate
• amyl nitrite oxidizes hemoglobin to methemoglobin with resultant formation of cyanomethemoglobin

More general terms

• antidote
• pharmacologic combination

Additional terms

• cyanide (CN-)
• methemoglobin (MetHb, Hi)
• thiosulfate sulfurtransferase; rhodanese (TST)

Components

• amyl nitrite; isoamyl nitrite
• sodium thiosulfate (Sodothiol)
• sodium nitrite (Erinitrit, Felmerine)