Falsely Low Carboxyhemoglobin Level after Hydroxocobalamin Therapy

Livshits, Zhanna; Lugassy, Daniel; Shawn, Lauren K.; Hoffman, Robert S.

doi:10.1056/nejmc1114820

Cited by 15 publications

(4 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…9,14,20,32,[37][38][39][40][41] When used in healthy volunteers and in smoke inhalation victims, its most common adverse events are chromaturia and reddening of the skin. 27,[44][45][46] Other less-frequent adverse events include rash, headache, injection site reaction, decreased lymphocyte count, nausea, pruritis, chest discomfort, dysphagia, and the rare occurrence of an allergic reaction, none of which have been reported as a significant morbidity. 27,[44][45][46] Other less-frequent adverse events include rash, headache, injection site reaction, decreased lymphocyte count, nausea, pruritis, chest discomfort, dysphagia, and the rare occurrence of an allergic reaction, none of which have been reported as a significant morbidity.…”

Section: Discussionmentioning

confidence: 99%

Use of Cyanide Antidotes in Burn Patients With Suspected Inhalation Injuries in North America

Dumestre

Nickerson

2014

Journal of Burn Care & Research

View full text Add to dashboard Cite

This study aimed to assess the use of cyanide antidotes and the determine the opinion on empiric administration of hydroxocobalamin in North American burn patients with suspected smoke inhalation injuries. An online cross-sectional survey was sent to directors of 90 major burn centers in North America, which were listed on the American Burn Association Web site. A multiple-choice format was used to determine the percentage of patients tested for cyanide poisoning on admission, the current administration of a cyanide antidote based solely on clinical suspicion of poisoning, and the antidote used. To ascertain views on immediate administration of hydroxocobalamin before confirmation of cyanide poisoning an option was included to expand the response in written format. Twenty-nine of 90 burn directors (32%) completed the survey. For the population of interest, the majority of burn centers (59%) do not test for cyanide poisoning on admission and do not administer an antidote based solely on clinical suspicion of cyanide poisoning (58%). The most commonly available antidote is hydroxocobalamin (50%), followed by the cyanide antidote kit (29%). The opinion regarding instant administration of hydroxocobalamin when inhalation injury is suspected is mixed: 31% support its empiric use, 17% do not, and the remaining 52% have varying degrees of confidence in its utility. In North America, most patients burnt in closed-space fires with inhalation injuries are neither tested for cyanide poisoning in a timely manner nor empirically treated with a cyanide antidote. Although studies have shown the safety and efficacy of empiric and immediate administration of hydroxocobalamin, most centers are not willing to do so.

show abstract

Section: Discussionmentioning

confidence: 99%

Use of Cyanide Antidotes in Burn Patients With Suspected Inhalation Injuries in North America

Dumestre

Nickerson

2014

Journal of Burn Care & Research

View full text Add to dashboard Cite

show abstract

“…12 Interference of CO hemoglobin (COHb) levels in patients treated with OHCbl poses a serious problem because it may result in a delay in diagnosis and/or treatment for CO poisoning. 13 Although this has been attributable to the 532-nm peak wavelength of OHCbl, which is close to the peak wavelengths of 525 and 575 nm of COoximetry and COHb, respectively, 14 this interference in the measurement of serum COHb levels by Fe III PIm3CD was not observed (Yamagiwa et al, submitted for publication) because its peak wavelength at pH 7.0 and 25 C is 422 nm. 8 The half-life of the injected Fe III PIm3CD in the blood was much shorter than that of OHCbl (Table 1); approximately 69% of the infused Fe III PIm3CD was excreted in the urine within 1 h compared to 72 h required for the excretion of the infused OHCbl in the urine.…”

Section: Discussionmentioning

confidence: 99%

Supramolecular ferric porphyrins and a cyclodextrin dimer as antidotes for cyanide poisoning

et al. 2013

View full text Add to dashboard Cite

Objectives: This study aimed to evaluate the antidotal effect of a newly developed supramolecular complex, ferric porphyrins and a cyclodextrin dimer (FeIIIPIm3CD), that possess a higher binding constant and quicker binding rate to cyanide ions than those of hydroxocobalamin (OHCbl) in the presence of serum protein. Methods: First, in vitro cytochrome activity and cell viability were evaluated in murine fibroblast cells cultured with various doses of FeIIIPIm3CD and potassium cyanide (KCN). Next, BALB/c mice were pretreated with intravenous OHCbl (0.23 mmol/kg), FeIIIPIm3CD (0.23 mmol/kg), or saline and then received KCN (lethal dose 100% (LD100): 0.23 mmol/kg) through a stomach tube. Finally, as a resuscitation model, KCN-induced apnea was treated with a bolus injection of an equimolar dose of antidotes followed by a slow infusion of the same reagent. Results: FeIIIPIm3CD showed dose-dependent antidotal effects in vitro. Pretreatment with FeIII PIm3CD prevented KCN-induced apnea significantly better than OHCbl. Resuscitation with FeIIIPIm3CD resulted in an earlier resumption of respiration than that seen with OHCbl. However, 24-h survival was similar among the treatments (FeIIIPIm3CD, nine of nine mice; OHCbl, eight of nine mice). Conclusion: FeIIIPIm3CD exerted significant antidotal effects on cyanide toxicity in vitro and in vivo, with a potency equal in the mortality of cyanide-poisoned mice or superior in the respiratory status during an acute phase to those of OHCbl.

show abstract

“…Livshits et al 18 reported conflicting effects on COHb in two human cases. In the first case, the patient's true COHb was 93% lower (2.5% vs 34.9%) following administration of 5 g of OHCob, as measured with a rapid blood gas analyzer.…”

Section: Effect Of Hydroxocobalamin On Laboratory Evaluationmentioning

confidence: 99%

Carbon Monoxide: The Other Silent Killer

Cumpston¹,

Rose²

2017

Emerg Med

View full text Add to dashboard Cite

A 50-year-old woman was pulled from the window of a burning building and found to be in cardiac arrest with pulseless electrical activity. Standard advanced cardiac life-support was started, and infusion of intra-osseous hydroxocobalamin (OHCob) was administered at the time of intubation because of the concern for cyanide (CN) gas exposure during smoke inhalation. Return of spontaneous circulation occurred before arrival at the hospital.Upon presentation to the ED, the patient's vital signs were: initial blood pressure (BP), 92/47 mm Hg; heart rate (HR), 112 beats/min; respiratory rate (RR), 31 breaths/min; and temperature (T), 99.7°F.Following intubation, the patient's oxygen saturation (SaO 2 ) on pulse oximetry (POX) was 93%, and her fraction of inspired oxygen (FiO 2 ) was 100%.On physical examination, the patient's face was covered with soot. The lung sounds were equal and clear to auscultation bilaterally. The neurological examination was significant for a Glasgow Coma Scale of 3, without administered sedation, and there were no signs of dermal burns. Initial arterial blood gas (ABG) results were: pH, 7.06; carbon dioxide partial pressure (PCO 2 ), 58 mm Hg; partial pressure of oxygen (PO 2 ), 152 mm Hg; bicarbonate (HCO 3 ), 17 mm Hg; SaO 2 , 98% (after intubation); FiO 2 , 100%; carboxyhemoglobin (COHb), 30%; and lactate, 14 mmol/L.

show abstract

Falsely Low Carboxyhemoglobin Level after Hydroxocobalamin Therapy

Cited by 15 publications

References 2 publications

Use of Cyanide Antidotes in Burn Patients With Suspected Inhalation Injuries in North America

Use of Cyanide Antidotes in Burn Patients With Suspected Inhalation Injuries in North America

Supramolecular ferric porphyrins and a cyclodextrin dimer as antidotes for cyanide poisoning

Carbon Monoxide: The Other Silent Killer

Contact Info

Product

Resources

About