The enzyme uses thiosulfate to convert the cyanide. However, if there is too much cyanide, then this enzyme is overwhelmed. There is an enzyme that converts cyanide to a form that can be eliminated from the body. The body can be routinely exposed to small amounts of cyanide and needs to be able to handle this small amount on an everyday basis. The third drug in the kit, Sodium Thiosulfate, helps the body detoxify the cyanide. Finally, the cost of the kit is more than $300, costly for large services with many ambulances. It tends to disappear from stocks as a result. In addition, there are security concerns as Amyl Nitrate, which is supplied in ampoules for inhalation before an IV can be started, has been reported to be used for aphrodisiac purposes. They are not in the typical formulary for EMS providers, and the most common cyanide exposure for EMS is likely to be a house fire when they should not be used anyway. The creation of methemoglobin in this situation would likely be fatal.Īmyl Nitrite and Sodium Nitrate create methemoglobinemia, and can be given if there is no exposure to carbon monoxide. However, if the victim has been exposed to carbon monoxide from a house fire, they will have even less functional hemoglobin as carboxyhemoglobin, which is created from exposure to CO, cannot carry oxygen either. 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. In the hospital, a common treatment is the Cyanide Antidote Kit.
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