Cyanide poisoning

Inhalational or oral cyanide poisoning in polymer fires, industrial accidents and amygdalin suicide attempts. Cyanide blocks mitochondrial complex IV; tissues stop using oxygen. Clinical: seizures, coma, metabolic acidosis, cardiac arrest. Antidote – hydroxocobalamin 5 g IV (Cyanokit) or a nitrite plus sodium thiosulfate combination.

ICD-10 T57.31 drug

Also known as: Cyanide intoxication, Smoke inhalation

Drugs used for this condition

AHydroxocobalaminFirst line · Vitamin B12 (European form of choice) and cyanide poisoning antidoteHydroxocobalamin as Cyanokit (SERB) is the first-line antidote for cyanide poisoning, including smoke inhalation from polymer fires. AEMPS registers Cyanokit 5 g IV. Dose: 5 g IV over 15 minutes (up to 10 g in severe poisoning). Advantage over nitrite plus sodium thiosulfate: no methaemoglobinaemia or hypotension, so safe with concurrent carbon monoxide poisoning. Colours skin, mucosa and urine red or pink for 1–7 days – not concerning, but distorts lab tests (bilirubin, creatinine, magnesium).

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit