FIELD REFERENCE
Full criteria & treatment guidance
Indications
- Suspected cyanide toxicity under PR-130, with its exposure and patient criteria.
Contraindications & local exclusions
- OCEMS PR-130 excludes known hydroxocobalamin allergy and requires a base order. The Cyanokit prescribing information lists no absolute contraindications; this does not override the OCEMS exclusion or authorize use for every smoke exposure.
Precautions
- Hypersensitivity, increased BP, renal injury and laboratory interference are cautions. Red skin/urine discoloration can occur. PR-130 prohibits simultaneous medications through the same IV/IO site; notify the receiving team.
- These are selected safety checks, not a complete prescribing monograph. Product labeling and OCEMS authorization answer different questions; confirm the actual product, patient population and applicable order.
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 / 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
- PR-130 pediatric dose: 70 mg/kg 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.
UNDERSTAND THE CARE
Why smoke exposure alone is not the complete indication
The guide links hydroxocobalamin to the cyanide indications in PR-130 and base authorization. Smoke exposure creates an assessment concern, but it does not automatically establish that every exposed patient needs the antidote. Describe the exposure, respiratory and circulatory findings and supporting history in the request.
Applying the guidance
Preparation requires attention to the exact kit, reconstitution, dose and infusion instructions. Preserve the dedicated-line requirement rather than assuming that a convenient occupied line is suitable. Record the amount and time delivered and communicate treatment during handoff, together with the response and the original suspected exposure.
Dose, concentration and volume
Diagram text & teaching checkpoints
- Clinical concern
- Exposure plus supporting findings.
- Authorization
- Required base order.
- Preparation
- Kit, reconstitution, dose and dedicated line.
- Infusion record
- Start, amount, timing and response.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.
- PR-130 — Hydroxocobalamin for Cyanide Toxicity
- SO-M-050 — Substance Overdose / Poisoning - Adult / Adolescent
- I-20 — Pediatric Medication Volume Dose by Weight
- 325.00 — Advanced Life Support (ALS) Provider Unit Minimum Inventory
- Product label — CYANOKIT- hydroxocobalamin injection, powder, lyophilized, for solution
- Name / formulation reference — Medication name and formulation terminology
Make treatment visible to the receiving team
A base order, a reconstituted kit and an administered dose are different events. Document them separately. If transport or transfer occurs during the infusion, the receiving team needs the ordered amount, prepared concentration, infusion start time, amount delivered and what remains. “Cyanokit given” can hide whether treatment was just started or completed.
The exposure history and original clinical findings should travel with the medication record. Treatment may alter the appearance of the patient and interfere with laboratory testing, so notify the receiving facility that hydroxocobalamin was administered rather than expecting staff to infer it from discoloration. Preserve the dedicated-line restriction during every transfer of tubing or vascular access.
For a drill, hand off a simulated patient midway through the infusion. Ask the receiving clinician to identify the treatment indication, base authorization, actual dose delivered and safe plan for the remaining infusion. The exercise is complete only when the medication record and the physical line agree.