Resuscitating Through the Smoke: Novel Use of Cyanocobalamin in a Pediatric House Fire Victim

Hydroxocobalamin (Cyanokit® (HealthTech BioActives, Spain)) is the first-line antidote for suspected cyanide toxicity, typically infused intravenously over 10-15 minutes. However, in critically unstable patients, faster delivery may be essential. This case describes a seven-year-old female patient found pulseless after exposure to heavy smoke in a residential fire. Following return of spontaneous circulation (ROSC) in the emergency department, the patient remained severely acidotic and hypoxic despite confirmation of a secure airway and initiation of mechanical ventilation. A 5 g dose of hydroxocobalamin was administered as a rapid push over two minutes. The intervention was well tolerated and associated with a significant 13.8% decrease in carboxyhemoglobin levels within 20 minutes, alongside progressive improvement in metabolic parameters. Although the patient ultimately suffered irreversible hypoxic-ischemic brain injury, this case highlights the potential utility of push-dose hydroxocobalamin in time-critical resuscitation scenarios involving suspected cyanide toxicity.