Sodium Thiosulphate

Liverpool Hospital Emergency Department


  • Cyanide Toxicity (empirical use) 


  • 25g/100mL vial  

Dosage and Administration: 

  • Mild cyanide poisoning as an alternative to hydroxocobalamin
    • 12.5g (50ml of 25% solution) IV over 10 minutes 
    • Paediatrics 400mg/kg to a maximum of 12.5g
    • Repeat after 30-60 mins if no improvement
  • Moderate to severe cyanide poisoning give WITH hydroxocobalamin
    • 12.5g (50ml of 25% solution) over 10 minutes
    • (paediatrics 400mg/kg up to max 12.5g)
    • Repeat after 30-60 minutes if there is no clinical improvement after the  second dose of hydroxocobalamin 

Side effects: 

  • Nausea and vomiting
  • Hypotension
  • Headache
  • Abdominal pain
  • Disorientation 

Pit Falls: 

  • Ensure cyanide level taken prior to administration