High-dose hydroxocobalamin for vasoplegic syndrome causing false blood leak alarm
نویسندگان
چکیده
Blood leak alarms are important safety features in a hemodialysis machine to protect patients from loss of blood through a rupture in the dialyzer membrane (true alarms). A false blood leak alarm can be triggered by air bubbles or detector malfunction (such as deposits of grease or scale). Hydroxocobalamin is an injectable form of vitamin B12 approved by the US Food and Drug Administration for the treatment of confirmed or suspected cyanide toxicity. Due to observations of an increase in arterial pressure after high-dose hydroxocobalamin infusion for the treatment of acute cyanide poisoning, it has recently been reported as an off-label rescue treatment for post-cardiopulmonary bypass vasoplegic syndrome. We report an 83-year-old man who received hydroxocobalamin following cardiac surgery for treatment of vasoplegic syndrome. The patient developed severe acute kidney injury with volume overload. Hydroxocobalamin interference with the blood leak detector compromised his dialysis treatment. We describe the use of continuous renal replacement therapy to overcome the hydroxocobalamin-related interference with hemodialysis. As the utility of hydroxocobalamin potentially expands, physicians must be aware of its inadvertent effect on renal replacement therapy.
منابع مشابه
The Use of Intravenous Hydroxocobalamin as a Rescue in Methylene Blue-resistant Vasoplegic Syndrome in Cardiac Surgery
Vasoplegic syndrome is a well-recognized complication during cardiopulmonary bypass (CPB) and is associated with increased morbidity and mortality, especially when refractory to conventional vasoconstrictor therapy. This is the first reported case of vasoplegia on CPB unresponsive to methylene blue whereas responsive to hydroxocobalamin, which indicates that the effect of hydroxocobalamin outsi...
متن کاملHemodialysis failure secondary to hydroxocobalamin exposure.
Hydroxocobalamin is a recently approved antidote for the treatment of cyanide poisoning. The case presented involves a young patient administered empiric hydroxocobalamin due to suspected cyanide overdose. Due to the development of acute kidney injury and severe metabolic derangement, emergent hemodialysis was initiated. Unfortunately, hemodialysis was confounded by a recurrent "blood leak" ala...
متن کاملRefractory Vasoplegic Syndrome in an Adult Patient with Infective Endocarditis: A Case Report and Literature Review
Postoperative vasoplegic syndrome (VS) is characterized by low systemic vascular resistance, normal or elevated cardiac output, and poor response to volume expansion. The incidence of VS after cardiac surgery requiring cardiopulmonary bypass is about 20%. Sometimes, VS becomes refractory and initial treatments do not work, rendering treatment a great challenge. In this study, we describe a youn...
متن کاملUpdate for Nurse Anesthetists Pathophysiology and Management of Angiotensin- Converting Enzyme Inhibitor–Associated Refrac- tory Hypotension During the Perioperative Period
Objectives At the completion of this course, the reader should be able to: 1. Describe the factors that control short-term and long-term blood pressure regulation. 2. Identify the therapeutic effects and side effects of ACE inhibitors. 3. Understand the two types of hypotension associated with the preoperative use of ACE inhibitors. 4. Explain the pathophysiology of vasoplegic syndrome. 5. Disc...
متن کامل