Cyanokit (Hydroxoxobalamin)

Question 1

Class / Action

Answer 1

Hydroxocobalamin - A form of Vitamin B-12

1. Binds to the cyanide ion forming cyanocobalamin which is excreted in the urine

Question 2

Onset / Duration of Action

Answer 2

Immediate Onset / Duration up to 24hours

Question 3

Indications

Answer 3

1. Treatment for known or suspected cyanide poisoning. SS/SX of high concentrations of cyanide exposure with an appropriate clinical history are indications for treatment
2. High Concentrations of cyanide SS/SX:
   a. Markedly ALOC
   b. Seizure
   c. Respiratory depression or arrest
   d. Cardiac Dysrhythmia (other than sinus tachycardia)

Question 4

Contraindications

Answer 4

Patients with known anaphylactic reactions to hydroxocobalamin or cyanocobalamin

Question 5

Precautions

Answer 5

Caution should be exercised when administering other cyanide antidotes simultaneously with Cyanokit, as safety has not been established. If a decision is made to administer another cyanide antidote with Cyanokit, these drugs Should Not be Administered Concurrently in the Same IV Line.

Question 6

Dosages / Administration

Answer 6

1. If able, collect a pre-treatment blood sample in the appropriate tube to assess cyanide level.
2. ADULT: Initial Dose 5gm/15min SLOW IV. (Each 5gm vial is to reconstituted with 200mL of 0.9% NS. Invert Repeatedly, but Do Not Shake to reconstitute). An additional 5gm dose may be administered.
3. PED: Dose is 70mg/kg (reconstitute concentration is 25mg/mL) over 15min SLOW IV. (Each 5gm vial is to be reconstituted with 200mL of 0.9% NS). Maximum Single Dose is 5gm

Question 7

Adverse Reactions

Answer 7

1. Reddish discoloration of the skin and urine (not to be confused with the rare sign of carbon monoxide poisoning). The devices that rely on colormetry (pulse oximetry and CO level) will be interfered with by the color change and are not reliable for patient assessment.
2. Rash, Increased BP, Nausea, HA, Injection site reactions, Allergic reactions.