Cyanide Toxicity

Cyanide toxicity • By preventing oxidative phosphorylation→ cellular hypoxia→ anaerobic metabolism • S/S→ lactic acidosis, tachyphylaxis to SNP, ↑ SvO2, Sz Management: • D/C SNP • 100% O2 • Thiosulfate 150 mg/kg IV administered over 15 minutes (acts as a sulfur donor to convert cyanide to thiocyanate) • If severe, with deteriorating hemodynamics and metabolic acidosis → slow IV administration of sodium nitrate, 5 mg/kg. ( converts Hb to methemoglobin, which acts as an antidote by converting cyanide to cyanomethemoglobin • hydroxocobalamin (vitamin B12a) which binds cyanide to form cyanocobalamin (vitamin B12) can be administered (25 mg/hour IV to a maximum of 100 mg)