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Field medications · Adult & pediatric guidance · ALS

Hydroxocobalamin (Cyanokit)

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

OCEMS source summary · Updated 2026-09-16

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.

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 / routeDose & limits
Base-ordered cyanide treatment5 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 weightDose — IV/IO over approximately 15 minutesVolume at 25 mg/mL after reconstitution
3 kg210 mg8.4 mL
4 kg280 mg11.2 mL
5 kg350 mg14 mL
6 kg420 mg16.8 mL
8 kg560 mg22.4 mL
10 kg700 mg28 mL
12 kg840 mg33.6 mL
15 kg1050 mg42 mL
20 kg1400 mg56 mL
25 kg1750 mg70 mL
30 kg2100 mg84 mL
35 kg2450 mg98 mL
40 kg2800 mg112 mL
45 kg3150 mg126 mL
50 kg3500 mg140 mL
60 kg4200 mg168 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.