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Poisoning Information for the Public & Health Care Professionals

Atlantic Canada Poison Centre
Antidote Kit Manual

1-800-565-8161 or 902-470-8161 | atlanticcanadapoisoncentre.ca
Last updated: 05/2019
Pediatric Adult
Last updated: 05/2019
Antidote
Adult

Sodium Thiosulfate

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Antidote
Adult

Sodium Thiosulfate

Indications

  • Cyanide poisoning from hydrogen cyanide gas (smoke inhalation), ingestion of cyanide salts, high dose nitroprusside infusions. May be used alone or in combination with hydroxocobalamin.

Dosage

  • Initially 12.5 g (50 mL of a 25% solution) IV direct over 10 minutes. If signs of poisoning persist or reappear after 30 minutes, sodium thiosulfate may be repeated at one-half of the initial dose (6.25 g sodium thiosulfate).

Administration

  • IV Direct: Administer a 25% solution undiluted over 10 minutes ( 2.5 to 5 mL/minute) . Blood pressure monitoring is required.

Compatibility, Stability

  • Compatible with sodium chloride 0.9%.
  • Should not be administered in the same intravenous line as hydroxocobalamin.
  • Protect vials from light.

Potential Hazards of Administration

  • Hypotension.
  • Nausea, vomiting, diarrhea.
  • Headache, disorientation, psychosis, arthralgia, hyperreflexia, muscle cramps, tinnitus, blurred vision (from excess thiocyanate production).
  • Lab interference with serum chloride measurement may result in misinterpretation of anion gap calculations and missed metabolic acidosis.

Miscellaneous

  • Increases the rate of detoxification of cyanide by the enzyme rhodanese by providing an extra sulfur.

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Bailey, B., Blais, R., Gaudreault, P., Gosselin, S., & Laliberte, M. (2009). Antidotes en toxicologie d'urgence (3rd ed.). Quebec, Canada: Centre antipoison du Quebec.

Borron, S. W., Bronstein, A. C., Fernandez, M. C., & et all. (2014). Walter F. G. (Ed.), AHLS advanced hazmat life support, provider manual (4th ed.). Tucson, Arizona: The University of Arizona College of Medicine.

Goldfrank, L. R., Nelson, L. S., Lewin, N. A., Howland, M. A., Hoffman, R. S., (2015). Goldfrank's toxicologic emergencies(Tenth ed.). New York: McGraw Hill.

Hall, A. H., Saiers, J., & Baud, F. (2009). Review article: Which cyanide antidote. Critical Reviews in Toxicology, 39(7), 541-552.

Micromedex, T. H. A. (2014). Micromedex health care systems. Retrieved from http://www.micromedexsolutions.com

Olson, K. R. (2007). Poisoning & drug overdose (Sixth ed.). New York: McGraw Hill.

Reade, M. C., Davies, S. R., Morley, T. M., & Jacobs, I. C. (2012). Review article: Management of cyanide poisoning. Emergency Medicine Australasia, 24, 225-238.

Shannon, M. W., Borron, S. W., & Burns, M. J. (2007). Haddad and Winchester's clinical management of poisoning and drug overdose (Fourth ed.). Philadelphia: Saunders Elsevier.

Wendroth, S. M., Heady, T. N., Haverstock, D. M., Bachmann, L. M., & Scott, M. G. (2014). Case report: Falsely increased chloride and missed anion gap elevation during treatment with sodium thiosulfate. Clinica Chimica Acta, 431, 77-79.