Miyuki Yamamoto1, Yasuyuki Watanabe2, Kent Doi1,2. 1. Department of Emergency and Critical Care Medicine The University of Tokyo Hospital Tokyo Japan. 2. Department of Medical Engineering The University of Tokyo Hospital Tokyo Japan.
A 70‐year‐old female patient with multiple cancers history was admitted with a burn index of 32.5 because of a house fire. Because of suspected cyanide poisoning, 5 g of hydroxocobalamin was injected using a commercially available kit (CyanoKit, Merck Biopharma Co., Ltd, Tokyo, Japan) at the emergency room. Six hours after admission, she was diagnosed with acute kidney injury with anuria. Continuous hemodiafiltration (CHDF) was initiated. She also had rhabdomyolysis (creatinine kinase 6,432 IU/L, myoglobin 11,765 ng/mL), but no evidence of hemolysis. Her skin showed pink coloration and reddish‐purple effluent fluid was observed from the beginning to the discontinuation of CHDF (Fig. 1A). Renal function and urine output gradually recovered, and similar pigmentation of urine to effluent fluid was observed (Fig. 1B).
Fig. 1
Reddish‐purple effluent fluid (A) and urine (B) were observed at the beginning of CHDF and 4 days after ICU admission.
Reddish‐purple effluent fluid (A) and urine (B) were observed at the beginning of CHDF and 4 days after ICU admission.Hydroxocobalamin, known as vitamin B12, is used as an antidote treatment for cyanide poisoning.
Hydroxocobalamin contains cobalt, which is red and characteristics water‐soluble, so the urine turned reddish as if blood in the urine. Some dialysis machines reportedly misrecognized blood leak because of dialysate discoloration by hydroxocobalamin.
A membrane of AN69‐ST (Baxter Limited., Tokyo, Japan), which can only partially remove myoglobin and free hemoglobin by filtration, and two dialysis machines of ACH‐Sigma (Asahi Kasei Medical Co., Ltd., Tokyo, Japan) and TR‐2020 (Toray Medical, Co., Ltd., Tokyo, Japan) were used and no false alarm of blood leak occurred. Of note, high myoglobin level in blood and effluent might influence the color of effluent fluid.
DISCLOSURE
Approval of the research protocol: Not applicable.Informed consent: Informed consent was obtained from the patient.Registry and the registration no. of the study/trial: Not applicable.Animal studies: Not applicable.Conflicts of interest: None declared.
Authors: M E Sutter; M E Clarke; J Cobb; G P Daubert; V S Rathore; L S Aston; R H Poppenga; J B Ford; K P Owen; T E Albertson Journal: Clin Toxicol (Phila) Date: 2012-11-14 Impact factor: 4.467
Fig. 1