Intravenous administration of a drug is subject to two constraints, first its preparation, and second its injection. Both steps are willingly considered as trivial. However, the modalities of the drug preparation and administration can be decisive, even crucial in the context of an emergency [1], [2]. To be optimal, those modalities have to meet several objectives, among which speed, precision, ease, safety, and economy of products are certainly the main ones, but are not always compatible with each other. These objectives should also be prioritized, for example to determine which between precision or speed should be preferred. When it comes to give an antidote to a child in a critical situation, this issue becomes burning. Thus, we wondered about the optimal modalities of preparation and administration of hydroxocobalamin in children.

Hydroxocobalamin is the antidote for cyanide poisoning [3]. One of the most common causes of this poisoning is inhalation of home-fire smoke or similar, then responsible for a high mortality [4]. In this case, children are particularly at risk of severe poisoning [5]. It is established that hydroxocobalamin should be administered in sufficient dose as soon as possible, and therefore from prehospital management if possible [5]. In our experience, 41 children were treated in prehospital setting during the last 10 year period (unpublished data). The drug comes in the form of a powder consisting of 5 g of hydroxocobalamin, in a glass vial. To meet the manufacturer's requirements that cannot be circumvented, it has to be diluted with 200 mL of 0,9% saline solution, at best. The vial has to be gently inverted (not shacked) during one minute before infusion. The solution so reconstituted in the vial is 200 mL containing 5 g of hydroxocobalamin. In children, the first dose of hydroxocobalamin to be administered is 70 mg/kg (without exceeding 5 g). The ideal duration of infusion is 15 min, but would be reduced in case of life-threatening intoxication. Neither the manufacturer, nor the literature is recommending the best way to administer the right dose out of this 200 mL vial. The questioning of the nurses in our department revealed that there was no standardized administration strategy. The objective of this study was to determine the mode of administration of hydroxocobalamin to be preferred, in emergency scenario, in children.