Hydroxocobalamin

Question 1

Generic name for Vitamin B12

Answer 1

Hydroxocobalamin

Question 2

Trade name for Hydroxocobalamin

Answer 2

Vitamin b12

Question 3

Classification of Hydroxocobalamin

Answer 3

Cyanide poisoning antidote

Question 4

MOA (Pharmacodynamics) of Hydroxocobalamin

Answer 4

A necessary coenzyme for metabolic process including: fat metabolism, carbohydrate metabolism and protein synthesis. It is also required for cell production

Question 5

Indication for Hydroxocobalamin

Answer 5

Known or suspected cyanide poisoning

Question 6

Dosages for Hydroxocobalamin

Answer 6

Cyanide Poisoning (with cardiac arrest or seizure):
Adult: 5g SIVP/IO (consult OLMC for repeat dose)
Pediatric: 70 mg/kg IV/IO to a single max of 5g

Cyanide Poisoning (all other patients):
Adult/Pediatric: 5g over 15 minutes. Another 5g may be infused over 15-120 min if clinical response not improved. Total max 10g.

Question 7

Contraindications for Hydroxocobalamin

Answer 7

Hypersensitivity to hydroxocobalamin, cobalt, or excipient.

Question 8

Precautions for Hydroxocobalamin

Answer 8

-May interfere with SPO2 and a co-oximeter levels in patients suspected of being exposed to cyanide
poisoning

-Red urine and red discoloration of skin and mucus membranes often occur

-Use the IV line provided in the kit as it contains a filter to remove any particles not visible due to the
solutions dark red colour

-For IO administration, a stopcock and syringe should be used with the IV line provided to administer
the antidote in increments over a period of 15 minutes.

-Patient may develop a rash

Question 9

Notable notes for Hydroxocobalamin

Answer 9

Not currently carried by EMS ground, but Fire services and Incident Response Paramedics do.

Inform receiving facilities of the administration of hydroxocobalamin because it may interfere with lab tests, including carboxyhemoglobin, methemoglobin, and hemoglobin

Do not shake to avoid foaming. Rock or invert the vial for at least 30 to 60 seconds