Pink skin, urine and effluent fluid after cyanide poisoning

Abstract

We are reporting a fatal case of cyanide intoxication due to voluntary ingestion treated by hydroxycobalamin as antidote. Twelve hours after ICU admission abnormal pink colored skin and urines were observed. The effluent fluid removed during the continuous veno-venous hemofiltration treatment also exhibited pink colour. Even though pink coloured skin and urines is a well-known side-effect of the hydroxycobalamin use as an antidote for cyanide, such an abnormal colour of the effluent fluid has not been previously reported. Contrary to what has been described with the haemodialysis machines whose functioning may be impaired by hydroxycobalamin, the device used to perform continuous renal replacement therapy has worked properly in present case. Therefore, continuous renal replacement therapy should be the first choice method if needed in this setting.

High-dose hydroxocobalamin for vasoplegic syndrome causing false blood leak alarm

“…One of the few recognized adverse effects from hydroxocobalamin is a dark reddish-purple discoloration of body fluids and skin, which can lead to interference with serum and urine laboratory colorimetric assays [ 18 , 26–30 ]. Chromaturia (red urine) can be observed after hydroxocobalamin treatment, lasting 7–35 days [ 7 ] and can be mistaken for hematuria [ 31 ].…”

“…Recently, Abdelmalek et al [ 24 ] and Debord et al [ 26 ] also reported the successful use of CRRT in the setting of hydroxocobalamin for the treatment of cyanide toxicity, in which the function of the CRRT machine was not impaired by hydroxocobalamin (a Prismaflex machine was used in the case described by Abdelmalek et al [ 24 ]). Thus, when facing difficulties with hemodialysis after the administration of hydroxocobalamin, consider attempting dialysis with a different manufacturer’s machine or model if available or contact the manufacturer directly.…”