Pralidoxime dosing for cyanide poisoning (smoke inhalation) with GCS < 8 includes which dose?

• A. Indicated for cyanide poisoning with GCS<8; adult 5 g over 15–20 min
• B. Indicated for OP only; dose 20 mg/kg
• C. Indicated for nerve agent; dose 10 g
• D. Not indicated for cyanide poisoning; avoid

Answer: (A)

In cyanide poisoning from smoke inhalation, rapid administration of the antidote that binds cyanide is essential. The standard adult dose is 5 grams given intravenously over about 15 minutes. This dose is designed to quickly sequester cyanide and allow the body to clear it, which is crucial when there is impaired consciousness (GCS < 8).

Pralidoxime, on the other hand, is used to treat organophosphate pesticides and nerve agent poisoning by reactivating acetylcholinesterase; it is not used for cyanide poisoning. Doses associated with OP/nerve agent treatment do not apply to cyanide cases.

So the dose that aligns with cyanide antidote therapy in this scenario is 5 grams over 15–20 minutes, reflecting hydroxocobalamin’s role rather than pralid oxime.