Laserfiche WebLink
# ADDITIONAL INFORMATION AND REFERENCES(continued) <br /> • "Preventive" use of cyanide antidote in the absence of <br /> impaired consciousness may not be warranted. Keep the <br /> patient calm by reassurance over the next 30 minutes, and <br /> closely monitor the patient' s condition. Consider assuring <br /> intravenous access in cases where significant toxicity is <br /> possible but may be delayed. Mildly symptomatic patients <br /> who remain alert may be managed by supportive care only. <br /> If cyanide skin contact has been prolonged and/or extensive, <br /> watch the individual closely at least 30 minutes to assure <br /> there is no delayed absorption into the bloodstream. <br /> INTRAVENOUS ANTIDOTE <br /> Establishment of IV access with normal saline, Ringer's <br /> lactate, or other available IV fluid will facilitate <br /> administration of the antidote. <br /> 1. Sodium nitrite: Adult - 10 ml of 3% solution (300 mg) <br /> Draw solution from the ampule and inject slowly over 4-5 <br /> minutes (2 to 2.5 ml/minute) . Monitor blood pressure <br /> frequently, and slow the rate of injection if hypotension <br /> (low blood pressure) occurs. <br /> 2. Sodium thiosulfate: Adult - 50 ml of 25% solution <br /> (12.5 grams) <br /> Follow sodium nitrite with sodium thiosulfate injected at <br /> a rate of 2.5 ml/minute (10-20 minutes) . <br /> The total time for injection of both components of the <br /> antidote at the recommended rates is lengthy, <br /> approximately 20-25 minutes. <br /> AVOID OVERTREATMENT <br /> Both amyl nitrite and sodium nitrite produce methemoglobin. <br /> Methemoglobin cannot carry oxygen or carbon dioxide, and <br /> therefore its presence reduces the oxygen carrying capacity <br /> of the blood. This itself is potentially harmful when <br /> methemoglobin levels exceed 20-30%. <br /> Consider the body weight and condition of the patient when <br /> treating a cyanide exposed patient with sodium nitrite. <br /> Avoid excessive use. Should injection be stopped for any <br /> reason, keep track of the amount administrated in case <br /> treatment needs to be restarted. <br /> If symptoms persist or recur after the initial treatment, <br /> repeat the antidote at one half the original doses one hour <br /> after the original administration. Monitor methemoglobin <br /> levels in every patient treated by the intravenous antidote. <br /> RECOVERY AND DISPOSITION <br /> (continued) <br /> 1252CR Page 11 <br />