TABLE 3: ANTIDOTE RECOMMENDATIONS FOLLOWING EXPOSURE TO CYANIDE (NYS, 2001)
Note - If the patient is a victim of recent smoke inhalation (may have high carboxyhemoglobin levels), administer only sodium thiosulfate.
Patient
Mild
(conscious)
Severe
(unconscious)
Other Treatment
Child If patient is conscious and has no other signs or symptoms, antidotes may not be necessary.

Sodium nitrite:1
0.12 - 0.33 ml/kg, not to exceed 10 ml of 3% solution2
slowly IV over no less than 5 minutes, or slower if hypotension develops

and

Sodium thiosulfate:
1.65 ml/kg of 25% solution IV over 10 - 20 minutes

For sodium nitrite-induced orthostatic hypotension, normal saline infusion and supine position are recommended.

If still apneic after antidote administration, consider sodium bicarbonate for severe acidosis.
Adult If patient is conscious and has no other signs or symptoms, antidotes may not be necessary.

Sodium nitrite:1
10 - 20 ml of 3% solution2
slowly IV over no less than 5 minutes, or slower if hypotension develops

and

Sodium thiosulfate:
50 ml of 25% solution IV over 10 - 20 minutes

1
If sodium nitrite is unavailable, administer amylnitrite by inhalation from crushable ampules. If neither is availble, then use sodium thiosulfate alone.
2
Available from Taylor Pharmaceuticals in cyanide antidote kit, formerly known as the Pasadena Cyanide Antidote Kit or the Lilly Cyanide Kit.