Hemodialysis Complications of Hydroxocobalamin: A Case Report

Mark E Sutter, Nadia Tereshchenko, Rokhsara Rafii, G. Patrick Daubert

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Hydroxocobalamin is a new antidote approved by the FDA for the treatment of cyanide poisoning. Our report describes a patient with cyanide poisoning who survived after treatment with hydroxocobalamin and complications we encountered with hemodialysis. A 34-year-old female presented to the emergency department after a syncopal event and seizures. Her systolic blood pressure was 75 mmHg, her QRS complex progressively widened, and pulses were lost. She was intubated and resuscitated with fluids, sodium bicarbonate for her QRS widening and vasopressors. Venous blood gas demonstrated a pH of 6.36 with an O2 saturation of 99%. Due to the acidemia with a normal pulse oximetry, simultaneous venous and arterial blood gases were obtained. Venous gas demonstrated a pH of 6.80 with a PO2 of 222 mmHg, an O2 saturation of 99%. The arterial blood gas showed a pH of 6.82, a PO2 518 mmHg, an O2 saturation of 100%. Cyanide was suspected and hydroxocobalamin and sodium thiosulfate were given. Within 40 min of hydroxocobalamin administration, vasopressors were discontinued. Initially, nephrology attempted dialysis for metabolic acidosis; however, the dialysis machine repeatedly shut down due to a "blood leak". This was an unforeseen effect attributed to hydroxocobalamin. Cyanide level, drawn 20 min after the antidote was completed, was elevated at 22 mcg/dL. Her urinary thiocyanate level could not be analyzed due to an "interfering substance". Hydroxocobalamin is an effective antidote. However, clinicians must be aware of its effects on hemodialysis machines which could delay the initiation of this important treatment modality in the severely acidemic patient.

Original languageEnglish (US)
Pages (from-to)165-167
Number of pages3
JournalJournal of Medical Toxicology
Volume6
Issue number2
DOIs
StatePublished - 2010

Fingerprint

Hydroxocobalamin
Renal Dialysis
Cyanides
Antidotes
Blood
Gases
Dialysis
Poisoning
Blood Pressure
Sodium Bicarbonate
Oximetry
Nephrology
Blood pressure
Acidosis
Hospital Emergency Service
Seizures
Therapeutics
Fluids

Keywords

  • Cyanide
  • Hemodialysis
  • Hydroxocobalamin

ASJC Scopus subject areas

  • Health, Toxicology and Mutagenesis
  • Toxicology

Cite this

Sutter, M. E., Tereshchenko, N., Rafii, R., & Daubert, G. P. (2010). Hemodialysis Complications of Hydroxocobalamin: A Case Report. Journal of Medical Toxicology, 6(2), 165-167. https://doi.org/10.1007/s13181-010-0067-9

Hemodialysis Complications of Hydroxocobalamin : A Case Report. / Sutter, Mark E; Tereshchenko, Nadia; Rafii, Rokhsara; Daubert, G. Patrick.

In: Journal of Medical Toxicology, Vol. 6, No. 2, 2010, p. 165-167.

Research output: Contribution to journalArticle

Sutter, ME, Tereshchenko, N, Rafii, R & Daubert, GP 2010, 'Hemodialysis Complications of Hydroxocobalamin: A Case Report', Journal of Medical Toxicology, vol. 6, no. 2, pp. 165-167. https://doi.org/10.1007/s13181-010-0067-9
Sutter, Mark E ; Tereshchenko, Nadia ; Rafii, Rokhsara ; Daubert, G. Patrick. / Hemodialysis Complications of Hydroxocobalamin : A Case Report. In: Journal of Medical Toxicology. 2010 ; Vol. 6, No. 2. pp. 165-167.
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