| Hemodialysis complications of hydroxocobalamin: a case report. | |
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MedLine Citation:
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PMID: 20352539 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Mark Sutter; Nadia Tereshchenko; Rokhsara Rafii; G Patrick Daubert |
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Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: Journal of medical toxicology : official journal of the American College of Medical Toxicology Volume: 6 ISSN: 1556-9039 ISO Abbreviation: J Med Toxicol Publication Date: 2010 Jun |
Date Detail:
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Created Date: 2010-08-11 Completed Date: 2010-10-29 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101284598 Medline TA: J Med Toxicol Country: United States |
Other Details:
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Languages: eng Pagination: 165-7 Citation Subset: IM |
Affiliation:
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Department of Emergency Medicine, University of California, Davis Medical Center, Sacramento, CA 95817, USA. mark.sutter@ucdmc.ucdavis.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acidosis
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chemically induced,
therapy Adult Antidotes / adverse effects*, therapeutic use Bipolar Disorder / complications Cyanides / poisoning Female Humans Hydroxocobalamin / adverse effects*, therapeutic use Renal Dialysis* Seizures / chemically induced Syncope / chemically induced Thiosulfates / therapeutic use |
| Chemical | |
Reg. No./Substance:
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0/Antidotes; 0/Cyanides; 0/Thiosulfates; 13422-51-0/Hydroxocobalamin; 7772-98-7/sodium thiosulfate |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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