Hydroxocobalamin (Cyanokit)

Question 1

Indications

Answer 1

Cyanide poisoning or smoke inhalation with suspected cyanide poisoning due to the presence of coma, persistent hypotension or cardiorespiratory arrest

Question 2

Side Effects/ Special Notes

Answer 2

A. The most frequently occurring side effects are chromaturia (red-colored urine) and erythema
(skin redness) which occur in nearly all patients.
B. Other reported serious side effects include allergic reactions, temporary increases in blood
pressure, nausea, headache and infusion site reactions.
C. Because of its deep red color, hydroxocobalamin has been found to interfere with certain
laboratory tests based on light absorption including co-oximetric measurements of
carboxyhemoglobin, methemoglobin and oxyhemoglobin.
D. If patient has suspected cyanide poisoning, consider obtaining SpCO, if available, before
administration of Cyanokit since the latter will interfere with the carboxyhemoglobin
monitor

Question 3

Adult dose

Answer 3

5 grams over 15 minutes

Question 4

Reconstitute the 5 gram vial of hydroxocobalamin with ___ of IV fluid (Lactated Ringers
or Normal Saline). Hydroxocobalamin has physical (particulate) and chemical incompatibilities with many medications and it is best to administer all other drugs or products (e.g., blood) through a separate intravenous line

Answer 4

200 mL