Sodium thiosulfate

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Background

  • Sulfur Donor that promotes conversion of cyanide to thiocyanate
  • Whereas the nitrites have adverse effects, sodium thiosulfate is non-toxic

Indications

  • Acute cyanide poisoning
  • Smoke inhalation with potential for cyanide exposure
  • Prophylaxis during nitroprusside infusions

Contraindications

  • None

Adverse Effects

  • Burning sensation and muscle cramping from infusion
  • Pregnancy Category C

Dosing

  • Cyanide Poisoning:
    • Adult: 12.5 g IV
    • Pediatric: 400 mg/kg IV
  • Prophylaxis during nitroprusside infusion:
    • Add 10 mg sodium thiosulfate for each 1 mg of nitroprusside

References

  • Olson, K. Poisoning and Drug Overdose, 1999.