Atlantic Canada Poison Centre
Antidote Kit Manual
Sodium Thiosulfate
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
CYANIDE POISONING:
- Infants and children: 400 mg/kg (1.6 mL/kg) of the 25% solution.
Max dose: 50 mL
|
Weight (kg) |
Dose (400 mg/kg) |
IV dose (mL) |
|
5 |
2000 mg (2 gm) |
8 |
|
10 |
4000 mg (4 gm) |
16 |
|
20 |
8000 mg (8 gm) |
32 |
|
30 (greater than or equal to) |
Adult dose 12.5 gm |
50 |
Adapted from Montello et al, 2006
Administration
- IV Direct: Administer a 25% solution (250 mg/mL) undiluted at a rate of 3 to 5 mL/minute (over a minimum of 10 minutes to avoid hypotension). Blood pressure monitoring is required.
Compatibility, Stability
- Compatible with sodium chloride 0.9%.
- Protect vials from light.
- Should not be administered in the same intravenous line as hydroxocobalamin.
Potential Hazards of Administration
- Hypotension.
- Nausea, vomiting, and 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
- Sodium thiosulfate increases the rate of detoxification of cyanide by the enzyme rhodanese.
References…
Montello M.J., Tarosky M, Pincock L et al. (2006) Dosing cards for treatment of children exposed to weapons of mass destruction. American Journal of Health-System Pharmacy; 63 (10) 944-949;
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.