How is hydroxocobalamin administered in smoke inhalation treatment?

• A. 5 g IV over 15 minutes
• B. 5 g IM
• C. 500 mg IV over 60 minutes
• D. 1 g IV bolus

Answer: (A)

When cyanide poisoning from smoke inhalation is suspected, hydroxocobalamin is given IV to bind cyanide quickly. The standard emergent dose is 5 g administered over about 15 minutes, providing rapid cyanide sequestration so tissues can resume oxygen use. Intravenous delivery ensures fast onset; administering by intramuscular route would delay absorption and delay treatment. The other dosing options are not appropriate because they are either far too small or not delivered in a way that achieves rapid, sufficient cyanide binding. A 5 g IV dose over 15 minutes is the widely accepted approach, with a second dose sometimes considered per local protocols if needed.