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Cyanide Exposure Medical Directive

A Primary Care Paramedic or an Advanced Care Paramedic may provide the treatment prescribed in this Medical Directive if authorized.

Indications

Suspected exposure to cyanide with signs and symptoms of poisoning.

Conditions

Sodium Thiosulfate 25%
Age N/A
LOA Altered
HR N/A
RR N/A
SBP N/A
Other N/A
Hydroxocobalamin
Age N/A
LOA Altered
HR N/A
RR N/A
SBP N/A
Other N/A

Contraindications

Sodium Thiosulfate 25%
Allergy or sensitivity to Sodium Thiosulfate 25%
Hydroxocobalamin
Allergy or sensitivity to Hydroxocobalamin

Treatment

Consider sodium thiosulfate 25%  
   Age Age 
  <18 years ≥18 years
  Route Route
  IV infusion IV infusion
Dose 1.65 ml/kg 12.5g (50 ml of 25% solution)
Max. single dose 12.5g (50 ml of 25% solution) 12.5g (50 ml of 25% solution)
Dosing interval N/A N/A
Max. # of doses 1 1
Consider hydroxocobalamin (if not using sodium thiosulfate 25%)
   Age Age 
  <18 years ≥18 years
  Route Route
  IV infusion IV infusion
Dose 70 mg/kg over 30 min. 5 g over 15 - 30 min.
Max. single dose 5 g 5 g
Dosing interval N/A N/A
Max. # of doses 1 1

Clinical Considerations

Hydroxocobalamin must be reconstituted with 200 ml normal saline prior to use.

Hydroxocobalamin Dosing Chart

Contact

Ministry of Health and Long-Term Care
5700 Yonge Street, 6th Floor
Toronto, ON M2M 4K5

416-327-7900

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