What is included in emergency department care (ED) care for cyanide toxicity?

Updated: May 30, 2020
  • Author: Inna Leybell, MD; Chief Editor: Michael A Miller, MD  more...
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Initial emergency department care for patients with cyanide exposure is identical to that provided in the prehospital phase. Provide supportive care, including the following:

  • Airway control, ventilation, and 100% oxygen

  • Crystalloids and vasopressors, as needed, for hypotension

  • Sodium bicarbonate, titrated according to arterial blood gas (ABG) and serum bicarbonate level

Decontaminate the patient with removal of clothing/skin flushing and/or activated charcoal (1g/kg), as appropriate. Activated charcoal should be given after oral exposure in alert patients who are able to protect the airway or after endotracheal intubation in unconscious patients. In recent ingestions, activated charcoal may be preceded by gastric lavage. The gastric aspirate may cause secondary contamination and should be viewed as hazardous.

Administer hydroxocobalamin or sodium thiosulfate and sodium nitrite if the diagnosis is strongly suspected. Do not wait for laboratory confirmation.

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