Medical Director’s Program Letter
Number:29-PA-08
Original Date:10-22-08
Revision Date:
Systems:All
Topic:Cyanokit (Generic Name: hydroxocobalamin)
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Background:Cyanide poisoning may result from inhalation, ingestion, or dermal exposure to various cyanide-containing compounds, including smoke from closed-space fires. Sources of cyanide poisoning include hydrogen cyanide and its salts, cyanogenic plants, aliphatic nitriles, and prolonged exposure to sodium nitroprusside.
The presence and extent of cyanide poisoning are often initially unknown. There is no widely available, rapid, confirmatory cyanide blood test. Treatment decisions must be made on the basis of clinical history and signs and symptoms of cyanide intoxication. If clinical suspicion of cyanide poisoning is high, Cyanokit should be administered without delay.
Signs and symptoms include:
Cardiovascular - initially, pulse decreases and BP rises, in later stages, possible tachycardia, dysrhythmias and cardiovascular collapse can occur, there may also be palpitations and/or chest tightness.
Respiratory - can cause immediate respiratory arrest, although initially there is usually an increase in the rate and depth of respirations, and later tachypnea, and pulmonary edema.
CNS - can cause immediate coma, although initially there is usually weakness, headache, and confusion; seizures are common.
GI - nausea/vomiting, salivation may be profuse, possible garlic taste in mouth.
Skin - pale, cyanotic or reddish color, dermatitis, sweating
Indication:CyanoKit is indicated for the treatment of known or suspected cyanide poisoning.Unlike the standard Cyanide Antidote kit (amyl nitrite, sodium nitrite and sodium thiosulfate),the CyanoKit does not cause methemoglobinemia. It works by directly binding the cyanide ions. Because of the lack of methemoglobin production, CyanoKit is safer in patients who may also have carbonmonoxide poisoning.
Dose and Administration:5 grams (2 vials) infused over 15 minutes. Reconstitute each vial (2.5 grams) with 100 ml of Normal Saline and then infuse the first vial over 7.5 minutes and repeat for the second vial.
Adverse Reactions: Usuallymild to moderate in severity and resolved spontaneously when the infusion was terminated or with standard supportive therapies.
Eye disorders: swelling, irritation, redness
Gastrointestinal disorders: difficulty swallowing, abdominal discomfort, vomiting, diarrhea
Immune system disorders: allergic reaction
Nervous system disorders: memory impairment, dizziness
Psychiatric disorders: restlessness
Respiratory disorders: dyspnea, throat tightness, dry throat
Skin disorders: urticaria, pruritus, hot flush
Medical directors’ guidelines:We recommend that cases of known or suspected cyanide poisoning be treated with the CyanoKit instead of the standard antidote kit. In addition to Cyanokit, treatment of cyanide poisoning must include supportive care including immediate attention to airway patency, adequacy of oxygenation and hydration, cardiovascular support, and management of any seizure activity. Decontamination measures should be employed based on the route of exposure. PPE should be utilized.
Please feel free to contact either Dr. Mailloux or myself if you should have any questions:
Wayne Lee, MD Mary Mailloux, MD
Medical Director Associate Medical Director
954-347-3277 Cell 954-347-3625 Cell
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