Successful use of continuous renal replacement therapy after hydroxocobalamin administration

Abdelmalek, Joseph A.; Thornton, Stephen L.; Nizar, John; Schneir, Aaron; Sanchez, Amber P.

doi:10.1002/dat.20572

Cited by 8 publications

(18 citation statements)

References 38 publications

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“…A further problem caused by hydroxocobalamin's pigment is false triggering of the sensor that detects blood leakage across the artificial kidney membrane during dialysis. This problem has been circumvented by recalibrating this sensor using a continuous renal replacement machine 71 …”

Section: Resultsmentioning

confidence: 99%

Review article: Management of cyanide poisoning

Reade

Davies

Morley

et al. 2012

Emerg Medicine Australasia

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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.

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Section: Resultsmentioning

confidence: 99%

Review article: Management of cyanide poisoning

Reade

Davies

Morley

et al. 2012

Emerg Medicine Australasia

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“…11 Gambro Phoenix X36, NxStage, and Prisma Flex dialysis machines are reported to be not affected by this dialysate discoloration due to hydroxocobalamin and can be safely used for dialysis in such patients. 8,11,12…”

Section: Discussionmentioning

confidence: 99%

A Case of Hydroxocobalamin-Induced False Blood Leak Alarm on Dialysis Machine

Datar

Sidhu

Virk

et al. 2019

Journal of Investigative Medicine High Impact Case Reports

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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.

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“…Initial reports suggested Cyanokit administration was safe prior to organ transplantation [ 18 ]. However, more recent reports have found hydroxocobalamin to be associated with failure of intermittent hemodialysis, thus limiting the opportunity to provide life-saving treatment should a transplanted allograft fail or experience delayed function [ 19 , 20 ]. The presumed mechanism for this phenomenon is the discoloration of bodily fluids triggering a “pseudo-blood leak” [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Successful Renal Transplantation after Presumed Cyanide Toxicity Treated with Hydroxocobalamin and Review of the Literature

Hendrix

Martins

Stoff

et al. 2018

Case Reports in Transplantation

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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.

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Successful use of continuous renal replacement therapy after hydroxocobalamin administration

Cited by 8 publications

References 38 publications

Review article: Management of cyanide poisoning

Review article: Management of cyanide poisoning

A Case of Hydroxocobalamin-Induced False Blood Leak Alarm on Dialysis Machine

Successful Renal Transplantation after Presumed Cyanide Toxicity Treated with Hydroxocobalamin and Review of the Literature

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