Details About Overdose or Poisoning Generic Salt ::  Thiosulfate, Sodium

Thiosulfate, Sodium

    

Drug Pharmacology ::

I. Pharmacology. Sodiumthiosulfate is a sulfur donor that promotes the conversion of cyanideto the less toxic thiocyanate by the sulfur transferase enzymerhodanese. Unlike nitrites, thiosulfate is essentially nontoxic and maybe given empirically in suspected cyanide poisoning. Well-designedanimal studies suggest enhanced antidotal efficacy whenhydroxocobalamin is used with thiosulfate.

Drug Indications ::

Indications

   

Maybe given alone or in combination with nitrites (see Nitrates andNitrites) or hydroxocobalamin (see Hydroxocobalamin) in patients withacute cyanide poisoning.

Empiric treatment of possible cyanide poisoning associated with smoke inhalation.

Prophylaxis during nitroprusside infusions (see Nitroprusside).

Extravasation of mechlorethamine (infiltrate locally; see Antineoplastic Agents).

E. Bromate salt ingestion (unproved).

Drug Contra-Indications ::

III. Contraindications. No known contraindications.

Drug Adverse Effects ::

IV. Adverse effects

   

Intravenous infusion may produce burning sensation, muscle cramping and twitching, and nausea and vomiting.

Use in pregnancy. FDAcategory C (indeterminate). This does not preclude its acute,short-term use in a seriously symptomatic patient (see Table III–1).

Drug Lab Interactions ::

Drug or laboratory interactions. Thiosulfate falsely lowers measured cyanide concentrations in several methods.

Drug Dose Management ::

Dosage and method of administration

   

For cyanide poisoning. Administer12.5 g (50 mL of 25% solution) IV at 2.5–5 mL/min. The pediatric doseis 400 mg/kg (1.6 mL/kg of 25% solution) up to 50 mL. Half the initialdose may be given after 30–60 minutes if needed.

For prophylaxis during nitroprusside infusions. Theaddition of 10 mg thiosulfate for each milligram of nitroprusside inthe intravenous solution has been reported to be effective, althoughphysical compatibility data are not available.

Drug Chemical Formulations ::

Formulations

   

Parenteral. Asa component of the cyanide antidote package, thiosulfate sodium, 25%solution, 50 mL. Also available separately in vials and ampulescontaining 2.5 g/10 mL or 1 g/10 mL.

The suggested minimum stocking levelto treat a 70-kg adult for the first 24 hours is two cyanide antidotepackages (one should be kept in the emergency department). Availablefrom Taylor Pharmaceuticals.

Disclaimer ::

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