Methemoglobinemia was evaluated in four patients after sodium nitrite administration. RESULTS: The mean observed half-life of cyanide was 3.0 +/- 0.6 hours. INTERVENTIONS: Peak level and half-life were determined by obtaining serial carboxyhemoglobin, cyanide, and methemoglobin levels. PARTICIPANTS: Seven critically ill smoke inhalation patients referred to the regional poison center. SETTING: Regional poison center and regional toxicology treatment center.

N2 - STUDY OBJECTIVE: To evaluate serial cyanide, methemoglobin, and carbon monoxide levels in smoke inhalation patients. If needed, a second dose (half of the initial dose) may be administered.T1 - Cyanide and methemoglobin kinetics in smoke inhalation victims treated with the cyanide antidote kit.

Sodium thiosulfate should be given IV immediately following sodium nitrite administration at a dose of 12.5 g.

If needed, a second dose of up to half the previous dose may be given, as long as methemoglobin levels are kept below 35-40%. A single dose of sodium nitrite is typically enough to raise methemoglobin levels to 20% in an adult.

Once the IV line is in place, amyl nitrite should be discontinued and 10 mL of 3% sodium nitrite (300mg) should be infused IV at a rate of 2.5 - 5.0 mL/min (2-4 mins).

Reapply until sodium nitrite can be administered (IV must be in place). Amyl nitrite should be given in alternate intervals of 15 sec followed by 15 sec rest, using a new ampule every 3 minutes.

Break and ampule of amyl nitrite in a handkerchief and hold it in front of the patients mouth/nose.1 Tourniquet & Instructions for Treatment.12 Ampules Amyl Nitrite Inhalants (0.3 mL).2 Vials Sodium Thiosulfate Injection (12.5 g in 50mL of water).2 Ampules Sodium Nitrite Injection (300 mg in10mL of water).

Cyanide treatment kit