Standard accepted therapy for cyanide poisoning in the United States is based on experimental and chemical principles developed in 1933. 5 The antidotes are contained in a kit now provided by Taylor Pharmaceuticals. The kit contains nitrites in two forms, an ampule of amyl nitrite for inhalation and 10 cc of a 3% solution of sodium nitrite for intravenous infusion. It also contains 50 cc of a 25% solution of sodium thiosulfate. The usual adult dose of sodium nitrite is 300 mg (10 mL of the 3% solution), followed by 12.5 g (50 mL of the 25% solution) of sodium thiosulfate. The pediatric dose is 0.33 mL/kg of 10% sodium nitrite and 1.65 mL/kg of 25% sodium thiosulfate.18 A case report of the death of a child who succumbed to methemoglobinemia following aggressive treatment of a nonlethal ingestion of cyanide has led to the standard practice of adjusting the pediatric dose of sodium nitrite according to the patient's hemoglobin level, as illustrated in T§.bieJ..8.2.i3.19, Inhaled amyl nitrite is used to temporize in the prehospital setting or until intravenous access can be obtained and does not need to be administered when sodium nitrite is readily available.
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