1
|
Evans J, Pandya A, Ding Y, Qunibi WY. Hydroxocobalamin-Induced Oxalate Nephropathy in a Patient With Smoke Inhalation. Kidney Int Rep 2021; 6:2228-2231. [PMID: 34386674 PMCID: PMC8343717 DOI: 10.1016/j.ekir.2021.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Jordan Evans
- Division of Nephrology, Department of Medicine, University of Texas Health Science Center, San Antonio, Texas
| | - Abhishek Pandya
- Division of Nephrology, Department of Medicine, University of Texas Health Science Center, San Antonio, Texas
| | - Yanli Ding
- Division of Nephrology, Department of Medicine, University of Texas Health Science Center, San Antonio, Texas
| | - Wajeh Y Qunibi
- Division of Nephrology, Department of Medicine, University of Texas Health Science Center, San Antonio, Texas
| |
Collapse
|
2
|
Crouch C, Hendrickse A, Gilliland S, Mandell MS. Unexpected Complication of Hydroxocobalamin Administration for Refractory Vasoplegia in Orthotopic Liver Transplant: A Case Report. Semin Cardiothorac Vasc Anesth 2019; 23:409-412. [PMID: 30985242 DOI: 10.1177/1089253219842662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 40-year-old male with alcoholic cirrhosis and end-stage renal disease presented for simultaneous liver and kidney transplantation. Hemodialysis was utilized intraoperatively during liver transplantation. During the procedure, the patient developed refractory hypotension and ultimately received hydroxocobalamin for vasoplegia. Shortly after administration, the hemodialysis machine ceased working after a "blood leak" alarm developed. Without the ability to continue intraoperative dialysis, the kidney transplantation portion of his surgery was postponed. The patient was transferred to the intensive care unit, where he underwent continuous renal replacement therapy overnight, and his kidney transplant proceeded the following morning.
Collapse
Affiliation(s)
- Cara Crouch
- University of Colorado Hospital, Aurora, CO, USA
| | | | | | | |
Collapse
|
3
|
Datar P, Sidhu JS, Virk J, Mukhtar O, Schmidt F, Gayam V. A Case of Hydroxocobalamin-Induced False Blood Leak Alarm on Dialysis Machine. J Investig Med High Impact Case Rep 2019; 7:2324709619883466. [PMID: 31701774 PMCID: PMC6843726 DOI: 10.1177/2324709619883466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Hemodialysis machines are equipped with a blood leak detector/alarm to prevent loss of blood following rupture of semipermeable membrane; the blood leak alarms could also be triggered by sensor malfunction or presence of air bubbles in the system. Hydroxocobalamin is a Food and Drug Administration–approved rapid-acting antidote to cyanide poisoning that converts cyanide to nontoxic cyanocobalamin. Side effects are reddish discoloration of skin and body fluids, urticarial rash, and rarely anaphylaxis. In this article, a case of false blood leak alarm following treatment of cyanide poisoning with hydroxocobalamin is reported, wherein the blood leak detector in dialysis machines prevented the patient from undergoing hemodialysis by repeatedly activating blood leak alarms. Continuous renal replacement therapy was used to overcome this problem. As the use of hydroxocobalamin increases, health care professionals should be educated about its potential to interfere with hemodialysis.
Collapse
Affiliation(s)
| | | | | | | | | | - Vijay Gayam
- Interfaith Medical Center, Brooklyn, NY, USA
| |
Collapse
|
4
|
Hendrix RJ, Martins PN, Stoff JS, Ahearn A, Bozorgzadeh A, Movahedi B. Successful Renal Transplantation after Presumed Cyanide Toxicity Treated with Hydroxocobalamin and Review of the Literature. Case Rep Transplant 2018; 2018:3753479. [PMID: 30271651 PMCID: PMC6151203 DOI: 10.1155/2018/3753479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/10/2018] [Accepted: 07/17/2018] [Indexed: 11/18/2022] Open
Abstract
We report two cases of successful renal transplantation with allografts from donors who suffered anoxic brain injury as the primary cause of death from house fires. Each was treated prophylactically with hydroxocobalamin (Cyanokit) for suspected cyanide toxicity. During organ procurement, gross examination was notable for deep discoloration of the parenchymal tissues. Approximately 6 and 18 months after transplantation, both recipients have excellent renal graft function and remain independent from hemodialysis (HD). Hydroxocobalamin is the antidote for suspected acute cyanide toxicity. While largely tolerated by the recipient, there is concern over the potential functional implications of the associated side effects of dramatic tissue discoloration and development of oxalate crystals. Furthermore, difficulties performing hemodialysis in patients treated with hydroxocobalamin have been reported due to discoloration of the effluent fluid impacting the colorimetric sensor, causing false alarms and repetitive interruptions. As such, many transplant centers in the United States (US) continue to reject these organs. We seek to highlight two cases of successful transplantation following donor administration of hydroxocobalamin (Cyanokit) and present the first documented case of successful perioperative intermittent hemodialysis following transplantation of an allograft exposed to hydroxocobalamin. Furthermore, we emphasize the importance of optimal organ utilization and caution against unnecessary refusal.
Collapse
Affiliation(s)
- Ryan J. Hendrix
- University of Massachusetts Medical School, Department of Surgery, Division of Organ Transplantation, USA
| | - Paulo N. Martins
- University of Massachusetts Medical School, Department of Surgery, Division of Organ Transplantation, USA
| | - Jeffrey S. Stoff
- University of Massachusetts Medical School, Department of Medicine, Division of Nephrology, USA
| | - Aaron Ahearn
- University of Massachusetts Medical School, Department of Surgery, Division of Organ Transplantation, USA
| | - Adel Bozorgzadeh
- University of Massachusetts Medical School, Department of Surgery, Division of Organ Transplantation, USA
| | - Babak Movahedi
- University of Massachusetts Medical School, Department of Surgery, Division of Organ Transplantation, USA
| |
Collapse
|
5
|
Cheungpasitporn W, Hui J, Kashani KB, Wittwer ED, Albright RC, Dillon JJ. High-dose hydroxocobalamin for vasoplegic syndrome causing false blood leak alarm. Clin Kidney J 2017; 10:357-362. [PMID: 28616214 PMCID: PMC5466086 DOI: 10.1093/ckj/sfx004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 01/17/2017] [Indexed: 12/20/2022] Open
Abstract
Blood leak alarms are important safety features in a hemodialysis machine to protect patients from loss of blood through a rupture in the dialyzer membrane (true alarms). A false blood leak alarm can be triggered by air bubbles or detector malfunction (such as deposits of grease or scale). Hydroxocobalamin is an injectable form of vitamin B12 approved by the US Food and Drug Administration for the treatment of confirmed or suspected cyanide toxicity. Due to observations of an increase in arterial pressure after high-dose hydroxocobalamin infusion for the treatment of acute cyanide poisoning, it has recently been reported as an off-label rescue treatment for post–cardiopulmonary bypass vasoplegic syndrome. We report an 83-year-old man who received hydroxocobalamin following cardiac surgery for treatment of vasoplegic syndrome. The patient developed severe acute kidney injury with volume overload. Hydroxocobalamin interference with the blood leak detector compromised his dialysis treatment. We describe the use of continuous renal replacement therapy to overcome the hydroxocobalamin-related interference with hemodialysis. As the utility of hydroxocobalamin potentially expands, physicians must be aware of its inadvertent effect on renal replacement therapy.
Collapse
Affiliation(s)
- Wisit Cheungpasitporn
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - John Hui
- Department of Anesthesiology, Division of Critical Care Medicine and Cardiothoracic Anesthesiology, Mayo Clinic, Rochester, MN, USA.,Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kianoush B Kashani
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.,Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Erica D Wittwer
- Department of Anesthesiology, Division of Critical Care Medicine and Cardiothoracic Anesthesiology, Mayo Clinic, Rochester, MN, USA.,Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Robert C Albright
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - John J Dillon
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
6
|
Case Files from the University of California San Diego Health System Fellowship Coma and Severe Acidosis: Remember to Consider Acetaminophen. J Med Toxicol 2016; 11:368-76. [PMID: 26153488 DOI: 10.1007/s13181-015-0492-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
7
|
Sutter ME, Clarke ME, Cobb J, Daubert GP, Rathore VS, Aston LS, Poppenga RH, Ford JB, Owen KP, Albertson TE. Blood leak alarm interference by hydoxocobalamin is hemodialysis machine dependent. Clin Toxicol (Phila) 2012; 50:892-5. [DOI: 10.3109/15563650.2012.744031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
8
|
Reade MC, Davies SR, Morley PT, Dennett J, Jacobs IC. Review article: management of cyanide poisoning. Emerg Med Australas 2012; 24:225-38. [PMID: 22672162 DOI: 10.1111/j.1742-6723.2012.01538.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Cyanide poisoning is uncommon, but generates interest because of the presumed utility of an antidote immediately available in those areas with a high risk of cyanide exposure. As part of its regular review of guidelines, the Australian Resuscitation Council conducted a systematic review of the human evidence for the use of various proposed cyanide antidotes, and a narrative review of the relevant pharmacological and animal studies. There have been no relevant comparative or placebo-controlled human trials. Nine case series were identified. Treatment with hydroxocobalamin was reported in a total of 361 cases. No serious adverse effects of hydroxocobalamin were reported, and many patients with otherwise presumably fatal poisoning survived. Sodium thiosulphate use was reported in two case series, similarly with no adverse effects. Treatment with a combination of sodium nitrite, amyl nitrite and sodium thiosulphate was reported in 74 patients, with results indistinguishable from those of hydroxocobalamin and sodium thiosulphate. No case series using dicobalt edetate or 4-dimethylaminophenol were identified, but successful use in single cases has been reported. Hydroxocobalamin and sodium thiosulphate differ from alternatives in having negligible adverse effects, and on the basis of current evidence are the antidotes of choice. The indications for the use of an antidote, the requirements for supportive care and a recommended approach for workplaces where there is a risk of cyanide poisoning are presented.
Collapse
Affiliation(s)
- Michael C Reade
- Australian Resuscitation Council, Royal Australasian College of Surgeons, College of Surgeons' Gardens, Melbourne, Australia.
| | | | | | | | | | | |
Collapse
|