RT Book, Section
A1 Howland, Mary Ann
A2 Nelson, Lewis S.
A2 Howland, Mary Ann
A2 Lewin, Neal A.
A2 Smith, Silas W.
A2 Goldfrank, Lewis R.
A2 Hoffman, Robert S.
SR Print(0)
ID 1163003901
T1 Nitrites (Amyl and Sodium) and Sodium Thiosulfate
T2 Goldfrank's Toxicologic Emergencies, 11e
YR 2019
FD 2019
PB McGraw-Hill Education
PP New York, NY
SN 9781259859618
LK accessemergencymedicine.mhmedical.com/content.aspx?aid=1163003901
RD 2024/04/24
AB Sodium  nitrite  is  an  effective  cyanide  (CN)  antidote  that  acts  best  when  administered  in  a  timely  fashion  and  is  followed  by  sodium  thiosulfate.  The  utility  of  amyl  nitrite,  a  volatile  drug  available  in  ampules  that  can  be  broken  and  administered  by  inhalation  while  sodium  nitrite  is  being  prepared  to  administer  intravenously,  is  questioned.39  This  combination  of  sodium  nitrite  followed  by  sodium  thiosulfate  was  the  only  antidote  combination  available  to  treat  CN  toxicity  before  the  US  Food  and  Drug  Administration  (FDA)  approval  of  hydroxocobalamin  in  December  2006.  Although  there  has  never  been  a  head-to-head  study  in  humans  comparing  hydroxocobalamin  with  the  combination  for  the  treatment  of  CN  toxicity,  the  advantages  of  hydroxocobalamin  are  that  it  works  quickly  and  directly  to  inactivate  CN  to  form  cyanocobalamin.  In  addition,  hydroxocobalamin  can  be  administered  to  patients  with  impaired  oxygen-carrying  capacity  from  elevated  concentrations  of  carboxyhemoglobin  (COHb),  methemoglobin,  or  sulfhemoglobin,  making  it  the  preferred  CN  antidote  under  most  circumstances.