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Pai SL, Torp KD, Insignares VC, DeMaria S, Giordano CR, Logvinov II, Li Z, Chadha R, Aniskevich S. Use of hydroxocobalamin to treat intraoperative vasoplegic syndrome refractory to vasopressors and methylene blue during liver transplantation. Clin Transplant 2024; 38:e15271. [PMID: 38485687 DOI: 10.1111/ctr.15271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/16/2024] [Accepted: 02/11/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION For patients with catecholamine-resistant vasoplegic syndrome (VS) during liver transplantation (LT), treatment with methylene blue (MB) and/or hydroxocobalamin (B12) has been an acceptable therapy. However, data on the effectiveness of B12 is limited to case reports and case series. METHODS We retrospectively reviewed records of patients undergoing LT from January 2016 through March 2022. We identified patients with VS treated with vasopressors and MB, and abstracted hemodynamic parameters, vasopressor requirements, and B12 administration from the records. The primary aim was to describe the treatment efficacy of B12 for VS refractory to vasopressors and MB, measured as no vasopressor requirement at the conclusion of the surgery. RESULTS One hundred one patients received intraoperative VS treatment. For the 35 (34.7%) patients with successful VS treatment, 14 received MB only and 21 received both MB and B12. Of the 21 patients with VS resolution after receiving both MB and B12, 17 (89.5%) showed immediate, but transient, hemodynamic improvements at the time of MB administration and later showed sustained response to B12. CONCLUSION Immediate but transient hemodynamic response to MB in VS patients during LT supports the diagnosis of VS and should prompt B12 administration for sustained treatment response.
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Affiliation(s)
- Sher-Lu Pai
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Klaus D Torp
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Vianca C Insignares
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Samuel DeMaria
- Department of Anesthesiology, Perioperative and Pain Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Chris R Giordano
- Department of Anesthesiology, University of Florida Health, Gainesville, Florida, USA
| | - Ilana I Logvinov
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Zhuo Li
- Department of Quantitative Health Science, Mayo Clinic, Jacksonville, Florida, USA
| | - Ryan Chadha
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Stephen Aniskevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida, USA
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Flamarion E, Reichert C, Sayegh C, de Saint Gilles D, Bariseel R, Arnoux JB, Schmitt C, Poli A, Karras A, Pouchot J, Cheminet G, Penet MA. [Abnormal urine color assessment: The urine wheel]. Rev Med Interne 2021; 43:31-38. [PMID: 33736891 DOI: 10.1016/j.revmed.2021.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 02/14/2021] [Indexed: 12/17/2022]
Abstract
Looking at the urine for diagnostic purposes, once performed by ancient Egyptians, can still provide some valuable clues in modern medicine. Several diseases have been named after their associated urine color and this underlines the clinical value of visual urine inspection: blue diaper disease, purple urine bag syndrome, black urine disease or porphyria. Abnormal urine color could be challenging for the clinician: it may reveal neoplastic disease (urologic cancer; melanoma), cell lysis (rhabdomyolysis; hemolysis), infection (lymphatic filariasis; malaria), enzyme deficiency (porphyria; alkaptonuria), medication or food intake. In this article, we present the diagnostic approach, the mechanisms involved and the main causes of abnormal urine color.
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Affiliation(s)
- Edouard Flamarion
- Hôpital Européen Georges Pompidou, Service de médecine interne, APHP-Centre, Université de Paris, France.
| | - Constance Reichert
- Hôpital Européen Georges Pompidou, Service de médecine interne, APHP-Centre, Université de Paris, France
| | - Caroline Sayegh
- Hôpital Européen Georges Pompidou, Service de médecine interne, APHP-Centre, Université de Paris, France
| | - David de Saint Gilles
- Hôpital Européen Georges Pompidou, Service de médecine interne, APHP-Centre, Université de Paris, France
| | - Romane Bariseel
- Hôpital Européen Georges Pompidou, Service de médecine interne, APHP-Centre, Université de Paris, France
| | - Jean Baptise Arnoux
- Hôpital Necker Enfants Malades, Centre de Référence des Maladies Héréditaires du Métabolisme, APHP-Centre, Université de Paris, France
| | - Caroline Schmitt
- Hôpital Louis Mourier, Centre Français des Porphyries, APHP-Nord, Centre de recherche sur l'inflammation, INSERM U1149, Université de Paris, France
| | - Antoine Poli
- Hôpital Louis Mourier, Centre Français des Porphyries, APHP-Nord, Centre de recherche sur l'inflammation, INSERM U1149, Université de Paris, France
| | - Alexandre Karras
- Hôpital Européen Georges Pompidou, Service de néphrologie, APHP-Centre, Université de Paris, France
| | - Jacques Pouchot
- Hôpital Européen Georges Pompidou, Service de médecine interne, APHP-Centre, Université de Paris, France
| | - Geoffrey Cheminet
- Hôpital Européen Georges Pompidou, Service de médecine interne, APHP-Centre, Université de Paris, France
| | - Marie Aude Penet
- Hôpital Européen Georges Pompidou, Service de médecine interne, APHP-Centre, Université de Paris, France
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Shaefi S, Mittel A, Klick J, Evans A, Ivascu NS, Gutsche J, Augoustides JG. Vasoplegia After Cardiovascular Procedures—Pathophysiology and Targeted Therapy. J Cardiothorac Vasc Anesth 2018; 32:1013-1022. [DOI: 10.1053/j.jvca.2017.10.032] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Indexed: 11/11/2022]
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Warner MA, Mauermann WJ, Armour S, Barbara DW. Red urinary discolouration following hydroxocobalamin treatment for vasoplegic syndrome. Can J Anaesth 2017; 64:673-674. [PMID: 28229373 DOI: 10.1007/s12630-017-0849-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 02/10/2017] [Accepted: 02/17/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Matthew A Warner
- Division of Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
| | - William J Mauermann
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Adult Cardiothoracic Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | - Sarah Armour
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Adult Cardiothoracic Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | - David W Barbara
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Adult Cardiothoracic Anesthesiology, Mayo Clinic, Rochester, MN, USA
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Kenefick RW, Heavens KR, Dennis WE, Caruso EM, Guerriere KI, Charkoudian N, Cheuvront SN. Quantification of chromatographic effects of vitamin B supplementation in urine and implications for hydration assessment. J Appl Physiol (1985) 2015; 119:110-5. [DOI: 10.1152/japplphysiol.00068.2015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 05/11/2015] [Indexed: 11/22/2022] Open
Abstract
Changes in body water elicit reflex adjustments at the kidney, thus maintaining fluid volume homeostasis. These renal adjustments change the concentration and color of urine, variables that can, in turn, be used as biomarkers of hydration status. It has been suggested that vitamin supplementation alters urine color; it is unclear whether any such alteration would confound hydration assessment via colorimetric evaluation. We tested the hypothesis that overnight vitamin B2 and/or B12 supplementation alters urine color as a marker of hydration status. Thirty healthy volunteers were monitored during a 3-day euhydrated baseline, confirmed via first morning nude body mass, urine specific gravity, and urine osmolality. Volunteers then randomly received B2 ( n = 10), B12 ( n = 10), or B2 + B12 ( n = 10) at ∼200 × recommended dietary allowance. Euhydration was verified on trial days (two of the following: body mass ± 1.0% of the mean of visits 1–3, urine specific gravity < 1.02, urine osmolality < 700 mmol/kg). Vitamin purity and urinary B2 concentration ([B2]) and [B12] were quantified via ultraperformance liquid chromatography. Two independent observers assessed urine color using an eight-point standardized color chart. Following supplementation, urinary [B2] was elevated; however, urine color was not different between nonsupplemented and supplemented trials. For example, in the B2 trial, urinary [B2] increased from 8.6 × 104 ± 7.7 × 104 to 5.7 × 106 ± 5.3 × 106 nmol/l ( P < 0.05), and urine color went from 4 ± 1 to 5 ± 1 ( P > 0.05). Both conditions met the euhydrated color classification. We conclude that a large overnight dose of vitamins B2 and B12 does not confound assessment of euhydrated status via urine color.
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Affiliation(s)
- Robert W. Kenefick
- US Army Research Institute of Environmental Medicine, Natick, Massachusetts; and
| | - K. R. Heavens
- US Army Research Institute of Environmental Medicine, Natick, Massachusetts; and
| | - W. E. Dennis
- US Army Center for Environmental Health Research, Fort Detrick, Maryland
| | - E. M. Caruso
- US Army Research Institute of Environmental Medicine, Natick, Massachusetts; and
| | - K. I. Guerriere
- US Army Research Institute of Environmental Medicine, Natick, Massachusetts; and
| | - N. Charkoudian
- US Army Research Institute of Environmental Medicine, Natick, Massachusetts; and
| | - S. N. Cheuvront
- US Army Research Institute of Environmental Medicine, Natick, Massachusetts; and
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Use of Cyanide Antidotes in Burn Patients With Suspected Inhalation Injuries in North America. J Burn Care Res 2014; 35:e112-7. [DOI: 10.1097/bcr.0b013e31829b3868] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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