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cyanide antidote pack
Indications: antidote to cyanide poisoning
Dosage:
1) 1st sodium nitrite 300 mg (10 mL) IV
2) 2nd sodium thiosulfate 12.5 grams (50 mL) by slow IV push
- repeat with 1/2 the dose as needed
3) 3rd amyl nitrite: inhale 1-6 times using 0.3 mL inhalants
- repeat every 3-5 minutes as needed
Kit contains:
1) sodium nitrite 300 mg/10 mL ampules
2) sodium thiosulfate 12.5 grams/50 mL ampules
3) amyl nitrite 0.3 mL ampules
4) stomach tube
5) syringes & needles
Pharmacokinetics:
1) sodium thiosulfate
a) distributes to extracellular fluid
b) 1/2life 30-40 minutes
c) excreted unchange in the urine
2) amyl nitrite inhalation:
a) onset of action 30 seconds
b) duration of action 3-5 minutes
Adverse effects:
1) tachycardia
2) hypotension
3) dizziness
4) headache
5) skin flushing
6) palpitations
7) nausea
8) diarrhea
Mechanism of action:
1) sodium thiosulfate used with sodium nitrite increases cyanide detoxification by sulfur donation to rhodanese, with conversion of cyanide to non-toxic thiocyanate
2) amyl nitrite oxidizes hemoglobin to methemoglobin with resultant formation of cyanomethemoglobin
Related
cyanide (CN-)
methemoglobin (MetHb, Hi)
thiosulfate sulfurtransferase; rhodanese (TST)
General
antidote
pharmacologic combination
References
- Drug Information & Medication Formulary, Veterans Affairs,
Central California Health Care System, 1st ed., Ravnan et al
eds, 1998
- Kaiser Permanente Northern California Regional Drug
Formulary, 1998
- Department of Veterans Affairs, VA National Formulary
Components
amyl nitrite; isoamyl nitrite
sodium nitrite (Erinitrit, Felmerine)
sodium thiosulfate (Sodothiol)