# Hydroxocobalamin (Cyanokit)

Adult and pediatric cyanide-antidote treatment with base authorization and a dedicated infusion line.

Population: Adult & pediatric guidance. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: See linked procedure for revision and implementation dates. Source checked September 16, 2026..
Canonical page: https://www.ocmedic.com/guides/hydroxocobalamin/
Official source: [PR-130 — Hydroxocobalamin for Cyanide Toxicity](https://www.ochealthinfo.com/sites/hca/files/import/data/files/85456.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Check before giving

- Known allergy to hydroxocobalamin is a contraindication in PR-130.
- Do not simultaneously give other medications through the same IV/IO site.

## Source documents

- [PR-130 — Hydroxocobalamin for Cyanide Toxicity](https://www.ochealthinfo.com/sites/hca/files/import/data/files/85456.pdf#page=1)
- [SO-M-050 — Substance Overdose / Poisoning - Adult / Adolescent](https://www.ochealthinfo.com/sites/hca/files/2021-10/SO-M-50%20Poisoning%20OD.pdf)
- [I-20 — Pediatric Medication Volume Dose by Weight](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf)
- [325.00 — Advanced Life Support (ALS) Provider Unit Minimum Inventory](https://www.ochealthinfo.com/sites/healthcare/files/2025-11/325.00%20ALS%20Minimum%20Equip%2010-2025.pdf)

## Use in OCEMS

- For known/suspected cyanide toxicity, including concerning smoke from burning plastics or petroleum products.
- PR-130 requires base contact for an order and consideration of burn-center destination.

## Adult / adolescent

| Indication / route | Dose & limits |
| --- | --- |
| Base-ordered cyanide treatment | 5 g in 200 mL normal saline, IV/IO over approximately 15 minutes, per SO-M-050 and PR-130. |

## Pediatric

- 70 mg/kg IV/IO over approximately 15 minutes, maximum 5 g, with a base hospital order.
- I-20 supplies weight-band volumes for the 25 mg/mL mixture. Verify the weight, ordered dose, concentration, and maximum before infusion.

## Pediatric weight table — Suspected cyanide toxicity

- Source: PR-130. Dose rule: 70 mg/kg; route: IV/IO over approximately 15 minutes.
- 70 mg/kg IV/IO over approximately 15 minutes; maximum 5,000 mg (5 g). Base hospital order required.
- For the 5 g Cyanokit described in PR-130, add 200 mL normal saline to produce 25 mg/mL. Rock/invert to mix; do not shake. Do not run other medications simultaneously through the same IV/IO site.
- Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.
- Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice.
| Exact weight | Dose — IV/IO over approximately 15 minutes | Volume at 25 mg/mL after reconstitution |
| --- | --- | --- |
| 3 kg | 210 mg | 8.4 mL |
| 4 kg | 280 mg | 11.2 mL |
| 5 kg | 350 mg | 14 mL |
| 6 kg | 420 mg | 16.8 mL |
| 8 kg | 560 mg | 22.4 mL |
| 10 kg | 700 mg | 28 mL |
| 12 kg | 840 mg | 33.6 mL |
| 15 kg | 1050 mg | 42 mL |
| 20 kg | 1400 mg | 56 mL |
| 25 kg | 1750 mg | 70 mL |
| 30 kg | 2100 mg | 84 mL |
| 35 kg | 2450 mg | 98 mL |
| 40 kg | 2800 mg | 112 mL |
| 45 kg | 3150 mg | 126 mL |
| 50 kg | 3500 mg | 140 mL |
| 60 kg | 4200 mg | 168 mL |

## Preparation & reassessment

- For the 5 g Cyanokit described by PR-130, add 200 mL normal saline using the transfer spike. Invert/rock for about 60 seconds; do not shake. Confirm a dark-red solution without visible particles.
- Remove the patient from exposure, provide high-flow oxygen and airway support, and monitor during infusion.
- Reddish skin/mucosal discoloration and increased blood pressure can occur. Notify the receiving team of administration before arrival.