- Oxygenation (the key agent)
- Activated charcoal (in case ingestion of salts within the last 4 hrs).
- Endotracheal intubation to facilitate oxygenation
- Hydroxocobalamin (Vit B-12) IV [ at Img/mL amp in Kenya; the main challenge being too dilute]
*It binds cyanide to form cyanocobalamin that is nontoxic.
*Dose: 70 mg/kg IV infusion over 15 mins (max. total dose 10g).
- Sodium thiosulphate IV [neither nor in the Kenyan market]
*It increases the rate of detoxification by formation of thiocyanate after the reaction with cyanide.
*Sodium nitrite [neither nor in the Kenyan market] is added to sodium thiosulphate IV to increase its potency but care is taken to ovoid excess hypotension.
*Dose: Sodium nitrite: 300mg IV at a rate of 2.5-5 mL/min
*Sodium thiosulphate: 12.5g IV infusion over 10 mins after sodium nitrite
- Sodium bicarbonate in case of marked lactic acidosis.
- *Lorazepam [neither nor in the Kenyan market] OR if not available.
- *Midazolam at Img/mL and 5mg/mL amp in Kenya]: 10mg IM once or 0.2 mg/kg IM once [Max. dose 10mg IM] OR if not available.
*Phenobarbitone at 120mg/2mL amp in Kenya]: 1.V at rate lower than 100mg/min [max. 15mg/kg]. 1.V at rate lower than 100mg/min [max. 15mg/kg].
- Pulse oximetry
- Monitor cardiac and respiratory functions.
- Serum lactate concentration
- Re-evaluate patients 7-10 days after discharge.