Cyanide poisoning

Treat immediately when exposure is strongly suspected
Hydroxocobalamin is preferred antidote in many settings
Sodium thiosulfate can be adjunctive/alternative
Give 100% oxygen + aggressive supportive care
Severe lactic acidosis supports the diagnosis
Do not delay antidote for confirmatory cyanide level

Use at a glance

Treat immediately when exposure is strongly suspected

Practical pearls

Hydroxocobalamin is preferred antidote in many settings
Sodium thiosulfate can be adjunctive/alternative

Other practical pearls

Give 100% oxygen + aggressive supportive care

Safety / pitfalls

Severe lactic acidosis supports the diagnosis
Do not delay antidote for confirmatory cyanide level

Self-check

When should strongly suspected cyanide poisoning be treated?
Immediately.
Which antidote is preferred in many cyanide-poisoning settings?
Hydroxocobalamin.

Drugs used for this (2)

Hydroxocobalamin ballicule — decagon mechanism diagram — Hydroxocobalamin

Sodium thiosulfate ballicule — decagon mechanism diagram — Sodium thiosulfate — off-label

All clinical uses · Open Cyanide poisoning in the interactive console ↗