NATIONAL
CALIFORNIA
VENTURA
policies
category
mechanism
- Hydroxocobalamin is a precursor to vitamin B12 which acts as a coenzyme for various metabolic functions, including fat and carbohydrate metabolism and protein synthesis, used in cell replication and hematopoiesis.
- In the presence of cyanide, each hydroxocobalamin molecule can bind one cyanide ion forming cyanocobalamin, which is then excreted in the urine.
indications
- Treatment of cyanide poisoning (known or suspected).
contraindications
- No absolute contraindications.
dosing
IV, IO: 5 g as single infusion over 15 minutes; may repeat a second 5 g dose over depending on the severity of poisoning and clinical response.
administration
IV, IO: Administer using the IV administration set provided in the Cyanokit.
onset
Rapid
duration
Varies with degree of cyanide exposure
notes
- Measuring cyanide level: Collection of pretreatment blood cyanide concentrations does not preclude administration and should not delay administration of suspected or confirmed cyanide toxicity. Only pretreatment cyanide concentrations may be useful since postinfusion concentrations may be inaccurate.
- Hypertension: Increased BP (≥180 mm Hg systolic or ≥110 mm Hg diastolic) may occur with infusion; elevations usually return to baseline within 4 hours.
- Fire victims: Hydroxocobalamin can discolor the skin complicating the assessment of burn severity.
dosage form
IV Solution: Cyanokit: 5 g (1 ea)
brand name
Cyanokit
adverse reactions
- Cardiovascular
- Chest discomfort
- Increased blood pressure
- Central nervous system
- Dizziness
- Headache
- Restlessness
- Dermatologic
- Erythema
- Skin rash
- Gastrointestinal
- Abdominal distress
- Nausea
- Genitourinary
- Urine discoloration (red)
- Kidney stones
structure
