What is the correct order of administration for the treatment of cyanide exposure?

The correct order of administration for the treatment of cyanide exposure begins with amyl nitrite, followed by sodium nitrite, and concludes with sodium thiosulfate.

Amyl nitrite is an inhaled antidote that serves to induce methemoglobinemia, which allows cyanide to bind to the hemoglobin instead of cytochrome enzymes, thereby reducing the toxic effects of cyanide. This initial step helps to quickly alleviate the life-threatening effects of cyanide poisoning.

Next, sodium nitrite is administered to create additional methemoglobin, facilitating a greater capacity to bind cyanide. This is important because it helps mitigate the hypoxic effects that arise from cyanide’s interference with cellular respiration. Sodium nitrite is a critical component in the detoxification process, ensuring that more cyanide is effectively sequestered.

Finally, sodium thiosulfate acts as a sulfur donor that assists in converting the bound cyanide to thiocyanate, which is significantly less toxic and can be excreted by the kidneys. This step completes the detoxification pathway, further enhancing the body’s ability to eliminate the cyanide from the system.

The order of administration is essential, as each component plays a vital role in treating cyanide exposure and