In patients that have been exposed to cyanide only, this would be fine - the body can survive with only 70 percent of hemoglobin functioning to carry oxygen. Normally we want to create about 30 percent methemoglobin. The downside of creating this form of hemoglobin, called methemoglobin, is that it cannot carry oxygen.

This will pull the cyanide out of the mitochondria of the cells and allow the resumption of normal energy production. One of the treatments for cyanide poisoning is to turn some of the hemoglobin in the body into a form that will attach to cyanide. Next, there is Sodium Nitrate for IV administration. First, there is Amyl Nitrite for inhalation. These are in short supply - often there is only one or two available to each emergency department. It is also known as the Lilly Kit, Pasadena Kit or the Taylor Kit. If needed, a second dose (half of the initial dose) may be administered.In the hospital, a common treatment is the Cyanide Antidote Kit.

Sodium thiosulfate should be given IV immediately following sodium nitrite administration at a dose of 12.5 g.

If needed, a second dose of up to half the previous dose may be given, as long as methemoglobin levels are kept below 35-40%. A single dose of sodium nitrite is typically enough to raise methemoglobin levels to 20% in an adult.

Once the IV line is in place, amyl nitrite should be discontinued and 10 mL of 3% sodium nitrite (300mg) should be infused IV at a rate of 2.5 - 5.0 mL/min (2-4 mins).

Reapply until sodium nitrite can be administered (IV must be in place).

Amyl nitrite should be given in alternate intervals of 15 sec followed by 15 sec rest, using a new ampule every 3 minutes.

Break and ampule of amyl nitrite in a handkerchief and hold it in front of the patients mouth/nose.

1 Tourniquet & Instructions for Treatment.

12 Ampules Amyl Nitrite Inhalants (0.3 mL).

2 Vials Sodium Thiosulfate Injection (12.5 g in 50mL of water).

2 Ampules Sodium Nitrite Injection (300 mg in10mL of water).

Lilly cyanide kit