If needed, a second dose (half of the initial dose) may be administered. This type of poisoning can occur if you are exposed to smoke from a house or industrial fire, if you swallow or breathe in cyanide, or if you get cyanide on your skin. Sodium thiosulfate should be given IV immediately following sodium nitrite administration at a dose of 12.5 g. Cyanokit (hydroxocobalamin) is a form of vitamin B-12used in an emergency to treat cyanide poisoning.If needed, a second dose of up to half the previous dose may be given, as long as methemoglobin levels are kept below 35-40%. A single dose of sodium nitrite is typically enough to raise methemoglobin levels to 20% in an adult. Cyanokit (containing the drug hydroxocobalamin, intravenous tubing, and a sterile spike for reconstituting the drug product with saline) may be used in the United States and other countries for the treatment of known or suspected cyanide poisoning. Once the IV line is in place, amyl nitrite should be discontinued and 10 mL of 3% sodium nitrite (300mg) should be infused IV at a rate of 2.5 - 5.0 mL/min (2-4 mins). Hydroxocobalamin was recently approved in the United States for use as a component of the Cyanokit. Reapply until sodium nitrite can be administered (IV must be in place). Amyl nitrite should be given in alternate intervals of 15 sec followed by 15 sec rest, using a new ampule every 3 minutes. Break and ampule of amyl nitrite in a handkerchief and hold it in front of the patients mouth/nose.1 Tourniquet & Instructions for Treatment.12 Ampules Amyl Nitrite Inhalants (0.3 mL).2 Vials Sodium Thiosulfate Injection (12.5 g in 50mL of water).2 Ampules Sodium Nitrite Injection (300 mg in10mL of water).
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