Na me of product: Sodium nitrite  Dosage  form: Injection (i.v.) Strength:  30 mg/mL  Pack size: 5 x 10 mL ampules Manufacturer: The Thai Red Cross Society (Thailand)

Uses

• cyanide poisoning (together with sodium thiosulfate).

 

Precautions

• anemia (monitor plasma methemoglobin levels); severe cardiovascular or cerebrovascular disease. Patients with smoke inhalation injury or carbon monoxide poisoning. Patient with methemoglobinemia level over 40%

Pregnancy category: C

Administration

• slow intravenous injection over 2 - 4 minutes (2.5 - 5 mL/min)

Dose

• ADULT, 300 mg (followed by sodium thiosulfate); further dose of 150 mg after 30 minutes if symptoms recur

• CHILD, 6 to 8 mL/m² BSA  or 6 mg/kg or 0.2 mL/kg (initially lower dose) not exceed 10 mL (300 mg) followed by sodium thiosulfate.

Hb (g/dL)	3% NaNO2 sol.  (mL/kg)	NaNO2 (mg/kg)
7.0	0.19	5.8
8.0	0.22	6.6
9.0	0.25	7.5
10.0	0.27	8.3
11.0	0.30	9.1
12.0	0.33	10.0
13.0	0.36	10.8
14.0	0.39	11.6

Adapted from Berlin CM: The treatment of cyanide poisoning in children. Pediatrics. 1970;46:793–796.

Adverse effect

• Transient hypotension, methemoglobinemia, headache, tachycardia palpitation dysrhythmias blurred vision,  nausea, vomiting

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Reference

• Tsutaoka B. Nitrite, Sodium, and Amyl. In: Olson KR, Anderson IB, Benowitz NL, Blanc PD, Clark RF, Kearney TE, et al., editors. Poisoning & Drug Overdose. 7th ed. New York: McGraw-Hill Education; 2018. p. 592-3.
• Howland MA. Nitrites (Amyl and Sodium) and Sodium Thiosulfate. In: Lewis S. Nelson, Howland MA, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS, editors. Goldfrank’s Toxicologic Emergencies. 11th ed. New York: McGraw-Hill Education; 2019. p. 1698 - 1702.