Table 3: Dosage of Sodium Nitrite and Sodium Thiosulfate for Cyanide Poisoning in Adults The rate of infusion should be decreased if significant hypotension is noted. (See Table 3 for dosage recommendations.) Blood pressure must be monitored during infusion. Sodium nitrite should be administered first, followed immediately by sodium thiosulfate. Both drugs are administered by slow IV injection. Sodium nitrite and sodium thiosulfate should be administered as early as possible after a diagnosis of acute life-threatening cyanide poisoning has been established.

If a decision is made to administer another cyanide antidote with sodium thiosulfate, these drugs should not be administered concurrently in the same IV line. The safety of administering other cyanide antidotes simultaneously with sodium thiosulfate has not been established.

Measurements of oxygen saturation using standard pulse oximetry and calculated oxygen saturation values based on measured PO 2 are unreliable in the presence of methemoglobinemia. When possible, obtain hemoglobin/hematocrit when treatment is initiated. Patients should be monitored for at least 24–48 hours after sodium thiosulfate administration for adequacy of oxygenation and perfusion and for recurrent signs and symptoms of cyanide toxicity. In patients with known anemia, it is recommended that the dosage of sodium nitrite should be reduced proportionately to the hemoglobin concentration.

If signs of poisoning reappear, repeat treatment using one-half the original dose of both sodium nitrite and sodium thiosulfate. Sodium thiosulfate (250 mg/mL): 1 mL/kg of body weight (250 mg/kg or approximately 30-40 mL/m 2 of BSA) not to exceed 50 mL total dose immediately following administration of sodium nitrite Sodium nitrite: 0.2 mL/kg (6 mg/kg or 6-8 mL/m 2 BSA) of sodium nitrite at the rate of 2.5 to 5 mL/minute not to exceed 10 mL Table 1: Dosage of Sodium Nitrite and Sodium Thiosulfate for Cyanide Poisoning in Pediatric Patients (See Table 1 for dosage recommendations.) Blood pressure must be monitored during infusion. Dosage summary: Pediatric Patients Acute Cyanide Poisoning It is essential that the manufacturer's labeling be consulted for more detailed information on dosage and administration of this drug. Injection: 12.5 g/50 mL (250 mg/mL) in a single-dose vial indicated for treatment of cyanide poisoning also available in a kit with sodium nitrite injection 300 mg/10 mL (30 mg/mL) in single-dose vials for the treatment of cyanide poisoning. Sodium thiosulfate is available in the following dosage form(s) and strength(s): Sodium Thiosulfate (Antidote) (Systemic) Dosage and Administration General Dosing recommendations for humans have been based on theoretical calculations of antidote detoxifying potential, extrapolation from animal experiments, and a small number of human case reports. Nearly all the human data describing the use of sodium thiosulfate report its use in conjunction with sodium nitrite. There are no randomized controlled clinical trials. The human data supporting the use of sodium thiosulfate and sodium nitrite for cyanide poisoning consists primarily of published case reports. The expert advice of a regional poison control center may be obtained by calling 1-80. Airway, ventilatory and circulatory support, and oxygen administration should not be delayed in order to administer sodium nitrite and sodium thiosulfate. Administration of sodium nitrite and sodium thiosulfate should be considered adjunctive to appropriate supportive therapies. Because of these risks, sodium thiosulfate and sodium nitrite should be used with caution in patients where the diagnosis of cyanide poisoning is uncertain.Ĭomprehensive treatment of acute cyanide intoxication requires support of vital functions.

Sodium nitrite causes hypotension and methemoglobin formation, which diminishes oxygen carrying capacity. If clinical suspicion of cyanide poisoning is high, administer sodium thiosulfate and sodium nitrite without delay and in conjunction with appropriate airway, ventilatory, and circulatory support. Sodium thiosulfate 250 mg/mL injection is indicated for sequential use with sodium nitrite for treatment of acute cyanide poisoning that is judged to be serious or life-threatening. Uses for Sodium Thiosulfate (Antidote) (Systemic) Acute Cyanide Poisoning Sodium thiosulfate is a cyanide antidote. Sodium Thiosulfate (Antidote) (Systemic) (Monograph)Ĭhemical name: dioxido-oxo-sulfanylidene-lambda6-sulfane

Poison antidote kit