Sodium thiosulfate enhances the endogenous cyanide detoxification capacity of the body. It is suitable to use alone in the treatment of mild to moderately severe cases of cyanide poisoning but should be used in conjunction with other antidotes such as hydroxocobalamin in severe cyanide toxicity.
- Administer 12.5 g sodium thiosulfate (50 ml of 25% solution) IV over 10 minutes or 200 mg/kg IV over 10 minutes.
- Repeat after 30 minutes if clinical features of cyanide toxicity persist.
- Paediatric dose = 400 mg/kg (relatively higher than for adults).
- Hall AH, Dart R, Bogdan G. Sodium thiosulfate or hydroxocobalamin for the empiric treatment of cyanide poisoning? Annals of Emergency Medicine 2007; 49:806-813.
- IPCS/CEC evaluation of antidotes series. Volume 2. Antidotes for poisoning by cyanide. Meredith TJ, Jacobsen D, Haines JA and Berger J-C. Cambridge University Press 1993.
Dr Neil Long BMBS FACEM FRCEM FRCPC. Emergency Physician at Kelowna hospital, British Columbia. Loves the misery of alpine climbing and working in austere environments (namely tertiary trauma centres). Supporter of FOAMed, lifelong education and trying to find that elusive peak performance.