Treatment of cyanide poisoning in Australasia

Abstract There is controversy about the most effective agent for cyanide poisoning. While dicobalt edetate has been recommended in Australia, hydroxocobalamin has been preferred in Europe. There are no comparative trials of these agents on which to base recommendations. However, a considerable volume of animal work and uncontrolled trials in humans suggest that hydroxocobalamin is safer and at least as effective. Thiosulphate appears to enhance the effect of hydroxocobalamin. The authors recommend that for patients with cyanide poisoning from smoke inhalation, significant self‐poisoning with cyanide or where there is strong clinical suspicion that cyanide poisoning is present, hydroxocobalamin should be given in a dose of 5–15 g over 30 min, or faster if necessary, accompanied by sodium thiosulphate 12.5 g over 10–20 min.