title: Toxicity of Food Drug and Cosmetic Blue No. 1 dye in critically ill patients.
abstract: Food Drug and Cosmetic Blue No. 1 dye (FD&C Blue No. 1) is commonly added to enteral nutrition formulations in order to facilitate the detection of gastric aspirate in tracheal secretions of critically ill patients. However, reports of systemic blue dye absorption and associated adverse outcomes are emerging. We report two cases of abnormal systemic absorption of FD&C Blue No. 1 in critically ill patients who subsequently died of refractory shock and metabolic acidosis. Risk factors and mechanisms of FD&C Blue No. 1 toxicity are discussed, and alternate approaches to gastric aspiration detection in critically ill patients are considered.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Pharmacy, The Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University Medical Center, 473 West Twelfth Avenue, Columbus, OH 43210-1252, USA.
authors.forename: Maria R
authors.initials: MR
authors.lastname: Lucarelli
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Shirk
authors.forename: Mark W
authors.initials: MW
authors.lastname: Julian
authors.forename: Elliott D
authors.initials: ED
authors.lastname: Crouser
mesh_terms: D000368:Aged; D001391:Azo Compounds / Q000633:toxicity*; D004396:Coloring Agents / Q000633:toxicity; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000628:therapy; D004750:Enteral Nutrition / Q000009:adverse effects; D017809:Fatal Outcome; D005260:Female; D005505:Food Coloring Agents / Q000633:toxicity*; D006801:Humans; D007362:Intensive Care Units; D007441:Intubation, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure; D011015:Pneumonia, Aspiration / Q000175:diagnosis*; D018570:Risk Assessment
chemical_list: D001391:Azo Compounds; D004396:Coloring Agents; D005505:Food Coloring Agents