Sodium thiosulfate

Background

• Sulfur donor that promotes conversion of cyanide to thiocyanate
• Whereas the nitrites have adverse effects, sodium thiosulfate is non-toxic

Indications

• Acute cyanide toxicity
• Smoke inhalation with potential for cyanide exposure
• Prophylaxis during nitroprusside infusions

Contraindications

• None

Adverse Effects

• Burning sensation and muscle cramping from infusion
• Pregnancy Category C

Dosing

• Cyanide Poisoning:
  • Adult: 12.5 g IV
  • Pediatric: 400 mg/kg IV
• Prophylaxis during nitroprusside infusion:
  • Add 10 mg sodium thiosulfate for each 1 mg of nitroprusside

See Also

• Cyanide toxicity

References

• Olson, K. Poisoning and Drug Overdose, 1999.