Cyanide Toxicity 

 

 

Considerations 

 

  • Life threatening emergency with high morbidity/mortality

  • Need to consult medical toxologist or poison control & treat appropriately without delay

  • Coexisting diseases:

    • Burns: carbon monoxide poisoning, smoke inhalation

    • Co-ingestions

 

 

Treatment 

 

  • Consult toxicology/ICU  

  • Secure airway & administer 100% O2 

  • Ensure all medical personnel have suits & respirators; decontaminate the patient (strip & discard clothing, wash all surfaces with soap & water)

  • Antidotes: 

    • Cyanide scavengers:

      • IV hydroxocobalamin = 1st line (dose = 70mg/kg, repeat X1 if needed) 

      • Nitrate such as IV sodium nitrite &/or inhaled amyl nitrite  

        • Downside is formation of methemoglobin & can cause hypotension, so hydroxycobalamin may be preferred

  • Sodium thiosulfate: 25 mL of 50% solution:

    • In the body, HCN is broken down by rhodanase, which detoxifies cyanide to thiocyanate

    • This process can be accelerated by provision of sodium thiosulfate, which provides a store of sulfane sulfur for the enzyme