title: Hemodialysis failure secondary to hydroxocobalamin exposure.
abstract: Hydroxocobalamin is a recently approved antidote for the treatment of cyanide poisoning. The case presented involves a young patient administered empiric hydroxocobalamin due to suspected cyanide overdose. Due to the development of acute kidney injury and severe metabolic derangement, emergent hemodialysis was initiated. Unfortunately, hemodialysis was confounded by a recurrent "blood leak" alarm. This unforeseen effect was secondary to interference from hydroxocobalamin. Hydroxocobalamin causes orange/red discoloration of bodily fluids and permeates the dialysate. This leads to defraction of light in the effluent path of the blood leak detector from discolored dialysate, which can result in activation of the blood leak alarm and an inability to continue hemodialysis treatment. This case highlights several new and emerging critical concerns with this medication, including the potential consequence of delayed initiation of emergent renal replacement therapy with empiric administration, the need for increased awareness among clinicians of various disciplines, and the need for multidisciplinary communication.
authors.affiliation: Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (Lim, Heher, Steele, Fenves, Tucker, Thadhani, Tolkoff-Rubin); and the Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Lim, Tucker, Christopher).
authors.forename: Kenneth
authors.initials: K
authors.lastname: Lim
authors.affiliation: Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (Lim, Heher, Steele, Fenves, Tucker, Thadhani, Tolkoff-Rubin); and the Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Lim, Tucker, Christopher).
authors.forename: Eliot
authors.initials: E
authors.lastname: Heher
authors.affiliation: Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (Lim, Heher, Steele, Fenves, Tucker, Thadhani, Tolkoff-Rubin); and the Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Lim, Tucker, Christopher).
authors.forename: David
authors.initials: D
authors.lastname: Steele
authors.affiliation: Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (Lim, Heher, Steele, Fenves, Tucker, Thadhani, Tolkoff-Rubin); and the Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Lim, Tucker, Christopher).
authors.forename: Andrew Z
authors.initials: AZ
authors.lastname: Fenves
authors.affiliation: Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (Lim, Heher, Steele, Fenves, Tucker, Thadhani, Tolkoff-Rubin); and the Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Lim, Tucker, Christopher).
authors.forename: John Kevin
authors.initials: JK
authors.lastname: Tucker
authors.affiliation: Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (Lim, Heher, Steele, Fenves, Tucker, Thadhani, Tolkoff-Rubin); and the Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Lim, Tucker, Christopher).
authors.forename: Ravi
authors.initials: R
authors.lastname: Thadhani
authors.affiliation: Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (Lim, Heher, Steele, Fenves, Tucker, Thadhani, Tolkoff-Rubin); and the Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Lim, Tucker, Christopher).
authors.forename: Kenneth
authors.initials: K
authors.lastname: Christopher
authors.affiliation: Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (Lim, Heher, Steele, Fenves, Tucker, Thadhani, Tolkoff-Rubin); and the Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Lim, Tucker, Christopher).
authors.forename: Nina
authors.initials: N
authors.lastname: Tolkoff-Rubin