Pseudo-blood leak? A hemodialysis mystery

Ávila, José G.; Prasad, Deepali; Weisberg, Lawrence S.; Kasama, Richard

doi:10.5414/cn107447

Cited by 9 publications

(12 citation statements)

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“…First, while the use of hydroxocobalamin remains an advantage compared to the cyanide antidote kit due to its low toxicity profi le, universal discoloration of bodily fl uids can impede the delivery of hemodialysis by inducing a "pseudo-blood leak" (10). Th e hemodialysis machine operates on the principle that blood passes on one side of a semipermeable membrane.…”

Section: Discussionmentioning

confidence: 99%

“…It has been postulated that hemodialysis machines that utilize a photodetector consisting of a single optical emitter designed to detect light scatter and signal drop off are unlikely to be aff ected by hydroxocobalamin (10). However, photodetectors that use a dual LED array that depends on light absorption, such as those on the Fresenius 2008K, are susceptible to the "pseudo-blood leak" phenomenon.…”

Section: Hemodialysis Failure Secondary To Hydroxocobalamin Exposurementioning

confidence: 99%

“…Kenneth Lim, MD, PhD, Eliot Heher, MD, David Steele, MD, Andrew Z. Fenves, MD, John Kevin Tucker, MD, Ravi Thadhani, MD, MPH, Kenneth Christopher, MD, and Nina Tolkoff-Rubin, MD X36 and the NxStage machine are unaff ected (10,13). It has been postulated that hemodialysis machines that utilize a photodetector consisting of a single optical emitter designed to detect light scatter and signal drop off are unlikely to be aff ected by hydroxocobalamin (10).…”

Section: Hemodialysis Failure Secondary To Hydroxocobalamin Exposurementioning

confidence: 99%

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Hemodialysis Failure Secondary to Hydroxocobalamin Exposure

Lim¹,

Heher²,

Steele³

et al. 2017

Baylor University Medical Center Proceedings

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Section: Discussionmentioning

confidence: 99%

Section: Hemodialysis Failure Secondary To Hydroxocobalamin Exposurementioning

confidence: 99%

Section: Hemodialysis Failure Secondary To Hydroxocobalamin Exposurementioning

confidence: 99%

See 1 more Smart Citation

Hemodialysis Failure Secondary to Hydroxocobalamin Exposure

Lim¹,

Heher²,

Steele³

et al. 2017

Baylor University Medical Center Proceedings

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“…Membrane integrity is important to maintain sterility and protect patients from inadvertent blood loss. Thus modern dialysis machines have been designed to cease operations when blood is detected in the dialysate [2]. The blood leak detector is placed in the dialysis solution outflow line and uses a sensor in the dialysate effluent path [3–5].…”

Section: Introductionmentioning

confidence: 99%

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

Cheungpasitporn

Hui

Kashani

et al. 2017

Clinical Kidney Journal

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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.

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“…After hydroxocobalamin administration, common adverse events include hypertension, chromaturia, pink skin discoloration, and interference with common laboratory assays (including hemoglobin, methemoglobin, lactate, and carboxyhemoglobin) [42]. Hydroxocobalamin potentially interferes with dialysis.…”

Section: What Are the Adverse Effects Associated With Hydroxocobalamimentioning

confidence: 99%

Case Files of the University of Massachusetts Toxicology Fellowship: Does This Smoke Inhalation Victim Require Treatment with Cyanide Antidote?

Hamad¹,

Babu

Bebarta

2016

J. Med. Toxicol.

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Cyanide toxicity is common after significant smoke inhalation. Two cases are presented that provide framework for the discussion of epidemiology, pathogenesis, presenting signs and symptoms, and treatment options of inhalational cyanide poisoning. An evidence-based algorithm is proposed that utilizes point-of-care testing to help physicians identify patients who benefit most from antidotal therapy.

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Pseudo-blood leak? A hemodialysis mystery

Abstract: Hydroxocobalamin is a treatment for cyanide toxicity with few side effects. We report a case of a hemodialysis patient whose treatment was compromised by hydroxocobalamin interference with the blood leak detector.

Cited by 9 publications

References 0 publications

Hemodialysis Failure Secondary to Hydroxocobalamin Exposure

Hemodialysis Failure Secondary to Hydroxocobalamin Exposure

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

Case Files of the University of Massachusetts Toxicology Fellowship: Does This Smoke Inhalation Victim Require Treatment with Cyanide Antidote?

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