Criteria for use:

1. Suspected cyanide toxicity (acute ingestion, smoke inhalation, etc.)
2. Contraindication* or failure of methylene blue AND suspected/confirmed vasoplegia
(Patient meets ALL of the following criteria):
1. Severe hypotension (MAP <60) refractory to ≥ 2 vasopressors
2. Low Systemic Vascular Resistance (<800 dynes/sec/cm5)
3. Normal or elevated Cardiac Index (>2.5 L/min/m2)

*Contraindication is defined as the concomitant use of methylene blue with serotonergic drugs due to risk of serious or fatal serotonin syndrome; please use the drug interaction checker at UpToDate or Micromedex to review interactions between methylene blue and drugs with serotonergic activity

Six (6) kits should remain in stock for emergency use - 4 at HH Main and 2 at W/C Hospital.

Use for other indications (e.g. vasoplegic syndrome) should be avoided if emergency stock is not sufficent.

Reviewed: April 22, 2008 (CYANOKIT), and 28 May 19 (Criteria for Use)

• Micromedex
• UpToDate
• Lippincott Advisor