It can, however, cause orange/red discoloration of skin, blood, urine, and secretions, and this can lead to statistically significant alterations in certain colorimetric tests and co-oximetry measurements ( 7– 9). The side-effect profile of hydroxocobalamin is considered minimal compared to its predecessor cyanide antidote kit ( 6). Hydroxocobalamin can therefore be safely used in cases where combined carbon monoxide and cyanide toxicity is suspected. This property makes it advantageous for patients with already decreased oxygenation, those who have been exposed to carbon monoxide, and pregnant patients. In contrast, hydroxocobalamin does not cause these complications. This kit contains amyl nitrite, sodium nitrite, and sodium thiosulfate, which can cause hypotension and reduced oxygen-carrying capacity of hemoglobin ( 3– 5). For decades, cyanide poisoning has been treated using the cyanide antidote kit ( 1, 2).
Hydroxocobalamin was approved by the Food and Drug Administration in December 2006 for the treatment of cyanide poisoning. This case highlights several new and emerging critical concerns with this medication, including the potential consequence of delayed initiation of emergent renal replacement therapy with empiric administration, the need for increased awareness among clinicians of various disciplines, and the need for multidisciplinary communication. This leads to defraction of light in the effluent path of the blood leak detector from discolored dialysate, which can result in activation of the blood leak alarm and an inability to continue hemodialysis treatment. Hydroxocobalamin causes orange/red discoloration of bodily fluids and permeates the dialysate. This unforeseen effect was secondary to interference from hydroxocobalamin. Unfortunately, hemodialysis was confounded by a recurrent “blood leak” alarm. Due to the development of acute kidney injury and severe metabolic derangement, emergent hemodialysis was initiated. The case presented involves a young patient administered empiric hydroxocobalamin due to suspected cyanide overdose. Hydroxocobalamin is a recently approved antidote for the treatment of cyanide poisoning.
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