Chemical Agents of Opportunity for Terrorism: TICs & TIMs

Chemical Agents of Opportunity for Terrorism
Training Support Package
Participant Guide
Slide 33
Chemical Agents of Opportunity for Terrorism:
TICs & TIMs
Cyanide Antidote Kit (CAK)
• 3-steps
– Amyl nitrite
– Sodium nitrite
– Sodium thiosulfate
• Converts cyanide to
thiocyanate
• One kit treats two people
Module Four – Cyanide & Fumigants
33
The first and oldest antidote is the 3-step cyanide antidote kit, still referred to as the “Lilly
kit”. The first step involves the inhalation of amyl nitrite in the nares of the victim to
induce a methemoglobinemia. Step two involves intravenous administration of sodium
nitrite another methemoglobin inducer. Methemoglobin can bind cyanide to form
cyanomethemoglobin. The third and last step involves the intravenous administration of
sodium thiosulfate which binds the cyanide from methemoglobin forming thiocyanate, a
renally excretable substrate. Sodium thiosulfate has a somewhat delayed onset of
action, which is why the methemoglobin inducers are used. One kit treats two adults, or
one adult twice, but full prescribing information is written on the box inside cover.
December 2008 Version 2.0 Page 220