Hemodialysis Failure Secondary to Hydroxocobalamin Exposure

Lim, Kenneth; Heher, Eliot; Steele, David; Fenves, Andrew Z.; Tucker, John K.; Thadhani, Ravi; Christopher, Kenneth B.; Tolkoff-Rubin, Nina

doi:10.1080/08998280.2017.11929569

Cited by 8 publications

(6 citation statements)

References 12 publications

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“…More remarkable is the apparent failure of established cyanide antidotes to display any ameliorative effect toward azide toxicity in human patients, particularly when they clearly protect mitochondrial function in an invertebrate model. 27 In fact, there is, seemingly, one case report in the literature suggesting that hydroxocobalamin might be of value as an azide antidote 28 and another to the contrary, 29 but nothing of a less anecdotal nature. If we accept the consensual viewpoint that the target for both poisons is primarily cytochrome c oxidase, then it is reasonable to expect similarities in behavior of azide and cyanide both in terms of their toxic mechanisms and responses to antidotes.…”

Section: ■ Discussionmentioning

confidence: 99%

A Cobalt Schiff-Base Complex as a Putative Therapeutic for Azide Poisoning

Praekunatham

Garrett

Bae

et al. 2019

Chem. Res. Toxicol.

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There is presently no antidote available to treat azide poisoning. Here, the Schiff-base compound Co(II)-2, 12-dimethyl-3,7,11,17-tetraazabicyclo-[11.3.1]heptadeca-1(17)2,11,13,15-pentaenyl dibromide (Co(II)N 4 [11.3.1]) is investigated to determine if it has the capability to antagonize azide toxicity through a decorporation mechanism. The stopped-flow kinetics of azide binding to Co(II)N 4 [11.3.1] in the absence of oxygen exhibited three experimentally observable phases: I (fast); II (intermediate); and III (slow). The intermediate phase II accounted for ∼70% of the overall absorbance changes, representing the major process observed, with second-order rate constants of 29 (±4) M −1 s −1 at 25 °C and 70 (±10) M −1 s −1 at 37 °C. The data demonstrated pH independence of the reaction around neutrality, suggesting the unprotonated azide anion to be the attacking species. The binding of azide to Co(II)N 4 [11.3.1] appears to have a complicated mechanism leading to less than ideal antidotal capability; nonetheless, this cobalt complex does protect against azide intoxication. Administration of Co(II)N 4 [11.3.1] at 5 min post sodium azide injection (ip) to mice resulted in a substantial decrease of righting-recovery times, 12 (±4) min, compared to controls, 40 (±8) min. In addition, only two out of seven mice "knocked down" when the antidote was administered compared to the controls given toxicant only (100% knockdown).

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Section: ■ Discussionmentioning

confidence: 99%

A Cobalt Schiff-Base Complex as a Putative Therapeutic for Azide Poisoning

Praekunatham

Garrett

Bae

et al. 2019

Chem. Res. Toxicol.

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“…It is likely that the different type of photodetector utilized by CRRT machines is the reason for its resistance to this interaction. 1,11,12 Also, the blood leak sensor is amenable to recalibration on CRRT machines, which will circumvent this issue. 11 As mentioned, this interaction has been reported previously in case reports, [1][2][3] but there is no discussion of the implications of this occurring intraoperatively.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Unexpected Complication of Hydroxocobalamin Administration for Refractory Vasoplegia in Orthotopic Liver Transplant: A Case Report

Crouch

Hendrickse

Gilliland

et al. 2019

Semin Cardiothorac Vasc Anesth

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A 40-year-old male with alcoholic cirrhosis and end-stage renal disease presented for simultaneous liver and kidney transplantation. Hemodialysis was utilized intraoperatively during liver transplantation. During the procedure, the patient developed refractory hypotension and ultimately received hydroxocobalamin for vasoplegia. Shortly after administration, the hemodialysis machine ceased working after a “blood leak” alarm developed. Without the ability to continue intraoperative dialysis, the kidney transplantation portion of his surgery was postponed. The patient was transferred to the intensive care unit, where he underwent continuous renal replacement therapy overnight, and his kidney transplant proceeded the following morning.

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“…While it is not possible to determine the exact reasoning for neighboring transplantation centers to decline the organs, discussions with the Organ Procurement Organization (OPO) highlighted genuine concern regarding the feasibility of perioperative dialysis. A recent study postulated that hemodialysis machines employing a photodetector consisting of a single optical emitter designed to detect light scatter and signal drop off are unlikely to be affected by hydroxocobalamin whereas those using a dual LED array that depends on light absorption are susceptible [ 22 , 23 ]. In congruence with this explanation, a multidisciplinary discussion was held at our institution prior to transplantation at which time it was confirmed the dialysis machine leak alarm could be overridden should dialysis be required.…”

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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Hemodialysis Failure Secondary to Hydroxocobalamin Exposure

Cited by 8 publications

References 12 publications

A Cobalt Schiff-Base Complex as a Putative Therapeutic for Azide Poisoning

A Cobalt Schiff-Base Complex as a Putative Therapeutic for Azide Poisoning

Unexpected Complication of Hydroxocobalamin Administration for Refractory Vasoplegia in Orthotopic Liver Transplant: A Case Report

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

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