- Vitamin (form of vitamin B12)
- Hydroxocobalamin binds directly with the cyanide molecule preventing the cyanide from binding to the cell’s mitochondria.
- Patients with known cyanide ingestion.
- Patients from enclosed space fires with altered level of consciousness (GCS<14).
- Allergy to hydroxocobalamin.
Caution in patients with:
- Single dose administration is safe in all patients who are not allergic to vitamin B12.
The dose of hydroxocobalamin is 70 mg/kg (typical adult dose is 5 g for a 71kg/155lbs person). A second half-dose may be given depending upon the severity of poisoning or the clinical response to treatment.
Route and Methods of Administration
- The onset is immediate. The half-life is 24 to 48 hours.
- The cyanocobalamin complex is excreted in the urine.
- May cause a temporary reddish discoloration of the skin, plasma, urine, and mucous membrane. These changes last for approximately two to three days.
IV infusion of hydroxocobalamin appears to interfere with co-oximetry measurements. This may complicate the assessment of smoke inhalation victims who may suffer from both cyanide and carbon monoxide poisoning.