- Reconstitute 1 ampoule (2.5g) with 100ml of 0.9% saline. Administer IV over 15 minutes.
- Repeat the process with the second ampoule.
- This should be sufficient to bind 100 mg of cyanide, if more have been ingested then further dosing will be required.
- If no improvement within 15 minutes then repeat administration or administer sodium thiosulfate (not in the same infusion)
- Therapeutic end points: Improved conscious state, haemodynamic stability and improvement in the metabolic acidosis
- In Cardiac Arrest – administer 5g IV push.
- Borron SW, Baud FJ, Megarbane B et al. Hydroxocobalamin for severe acute cyanide poisoning by ingestion or inhalation. American Journal of Emergency Medicine 2007; 25:551-518.
- Hall AH, Dart R, Bogdan G. Sodium thiosulfate or hydroxocobalamin for empiric treatment of cyanide poisoning? Annals of Emergency Medicine 2007; 49:806-813.
- IPCS/CEC evaluation of antidotes series. Volume 2. Antidotes for poisoning by cyanide. Meredith TJ, Jacobsen D, Haines JA and Berger J-C. Cambridge University Press 1993.