Cyanokit

Liverpool Hospital Emergency Department

 Indications: 

  • Cyanide poisoning with signs of serious clinical toxicity and suspected CN exposure.
  • Altered mental state / seizures / hypotension / significant lactic acidosis with normal  o2 saturations.  

In moderate to severe cyanide poisoning use in combination with sodium  thiosulfate. 

Formulation: 

  • 5g vial, powder  

Dosage and Administration 

  • Reconstitute the vial with 200mL of Sodium Chloride 0.9% or 5% dextrose using the  supplied sterile transfer device.
  • Invert the vial repeatedly for at least 1 minute to mix.
  • Do not shake.
  • Reconstituted solution is dark red, hence insoluble particles may not be visible.
  • Use the provided IV infusion set as it includes a filter. 
  • Adults:
    • 5g (200mL) IV, infused over 15 minutes.
  • Paediatrics (0-18years old):
    • 70mg/kg (not exceeding 5g) IV, infused over 15  minutes. 

Weight  

(kg)

5 

10 

20 

30 

40 

50 

60

Dose (g) 

0.35 

0.70 

1.40 

2.10 

2.80 

3.50 

4.20

Dose (mL) 

14 

28 

56 

84 

112 

140 

168

 

  • Subsequent dose:
    • Depending on the severity of the poisoning and the clinical  response, a second dose may be administered.
    • Please consult toxicologist.
    • A repeat  dose may be required after 30-60 minutes if there is no clinical improvement.
    • However, consider an alternative diagnosis in this event too. 
  • Rate of infusion for the second dose ranges from 15 minutes (for extremely unstable  patients) to 2 hours. 

Side Effects 

  • Skin redness may last up to 2 weeks
  • Urine discolouration up to 5 weeks after administration
  • Acne-like rash may appear after 7 to 28 days and lasts a few weeks
  • Hypertension / bradycardia and tachycardia may occur 
  • Hypersensitivity may occur