![]() ![]() ![]() Max dose should not exceed 10mL Do not give faster than 5mL/min (to avoid hypotension) Disposition Sodium nitrite (Pediatric Dosing) Hb Level (g/dL) may repeat at 1/2 original dose if needed.Pediatric dosing is based on Hemoblogin (see Peds dosing below).Lack of measurable MetHb levels after administration confirms CN presence.10mg/kg IV over 5min (use instead of amyl nitrite if IV is available).Hold under patient's nose for 30s of each minute, for 3 minutes.Inhaled by patient (only use if unavailable to obtain IV).Avoid nitrites in presence of severe hypotension if diagnosis is unclear.Induction of metHb further decreases O2 delivery.Nitrites are relatively contraindicated in patients with concomitant CO toxicity.Thiosulfate: donates its sulfur group to cyanide to form thiocyanate (less toxic than CN).Nitrites: form metHb which binds cyanide more avidly than cytochrome oxidase.Consider using only Na thiosulfate (no nitrites) in cases where concern for CO poisoning since nitrate administration will severely decrease oxygen carrying capacity.2nd line therapy - use if Cyanokit unavailable.The thiosulfate is a sulfate donor, which allows the enzyme rhodanese to convert the cyanide to thiocyanate that can be renally excreted. The nitrites convert the iron in hemoglobin from the ferrous to the ferric form, creating methemoglobinemia. OBTAIN Co-ox and labs prior to Hydroxocobalamin administration Cyanide Antidote Package (Lilly kit)Ĭomposed of two drugs(2 nitrites and a thiosulfate). Interferes with colorimetric tests - Pulse ox, Hemoglobin, Carboyxhemoglobin, methemeglobin, oxyhemoglobin, Serum Cr, AST/ALT, bilirubin, magnesium for 2-3 days.May cause temporary reddish discoloration of skin, plasma, urine, mucous membranes.Also give 25% sodium thiosulfate 1.65ml/kg IV (12.5g max dose) over 10min may repeat at half original dose if needed.Give 70mg/kg IV over 15min (5g is standard adult dose) may repeat 5g once as needed.Give empirically if cyanide poisoning is suspectedĭirectly binds cyanide forming cyanocobalamin which is readily excreted in the urine.Bicarb for acidemia (enchances of effect of nitrite and thiosulfate).PO2 of venous blood similar to arterial blood.Severe unexplained metabolic acidosis (lactic).Smell of bitter almonds (only 60-80% of population can detect this). ![]()
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