Hydroxocobalamin

Uh, severe cyanide toxicity can cause altered mental status, hypotension, seizures, cardiovascular collapse, severe lactic acidosis, and then eventually cardiac arrest.

Hydroxocobalamin, okay, it's a B vitamin, it's just a hard, it's hard to say, okay, is used as an antidote for sub-suspected severe cyanide poisoning.

And a lot of the times the ambulance may not carry this, but because it is, um, a risk of, um, a- injury during like structure fires and things like that, the fire department might carry it.

So it's worth ax- asking if you don't have it.

Um, hydroxocobalamin is lab and dialysis interference.

Methylene blue can cause the urine to be a blue-green.

Hydroxocobalamin can cause the urine to be a red color, um, but again, not injuring, um, not injurious, just color changing.

Visual clues, like we talked about, um, the blue-green discoloration versus the red discoloration for methylene blue and hydroxocobalamin respectively.

And then the evidence quality is similar for both, which is very limited, mostly small studies.

Yes.

You must immediately administer hydroxocobalamin, commonly known as vitamin B twelve A or the Cyanokit.

And what does that do?

Hydroxocobalamin directly binds the circulating cyanide molecules, forming cyanocobalamin, which is just standard vitamin B twelve that is safely and rapidly excreted in the urine.