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Poisoning Information for the Public & Health Care Professionals
Last updated: 03/2017

Sodium Thiosulfate

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Sodium Thiosulfate


  • 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.



  • 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)


2000 mg (2 gm)



4000 mg (4 gm)



8000 mg (8 gm)


30 (greater than or equal to)

Adult dose 12.5 gm


Adapted from Montello et al, 2006


  • 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


  • Sodium thiosulfate increases the rate of detoxification of cyanide by the enzyme rhodanese.

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.