Asunto(s)
Hidroxocobalamina , Humanos , Masculino , Hidroxocobalamina/uso terapéutico , Hidroxocobalamina/efectos adversos , Hidroxocobalamina/administración & dosificación , Infusiones Intravenosas , Complejo Vitamínico B/uso terapéutico , Complejo Vitamínico B/administración & dosificación , AncianoAsunto(s)
Cobalto/sangre , Hidroxocobalamina/efectos adversos , Vasoplejía/sangre , Biomarcadores/sangre , Cobalto/efectos adversos , Humanos , Hidroxocobalamina/administración & dosificación , Masculino , Persona de Mediana Edad , Vasoplejía/inducido químicamente , Vasoplejía/tratamiento farmacológico , Complejo Vitamínico B/administración & dosificación , Complejo Vitamínico B/efectos adversosRESUMEN
Hydroxocobalamin (vitamin B12a) is an emerging treatment for vasoplegic syndrome (VS) associated with cardiopulmonary bypass (CPB). Given its cost and scarcity, an institutional guideline for its use as a rescue treatment in cases of suspected VS was developed. Hemodynamic variables and vasopressor requirements were reviewed for a series of 24 post-CPB patients who received B12a. Favorable changes in hemodynamic parameters and vasopressor requirements were seen after B12a administration although guideline criteria for VS were inconsistently met. These findings support the continued study of B12a in patients with CPB-associated VS.
Asunto(s)
Puente Cardiopulmonar/efectos adversos , Hemodinámica/efectos de los fármacos , Hidroxocobalamina/uso terapéutico , Hipotensión/tratamiento farmacológico , Vasoconstrictores/uso terapéutico , Vasoplejía/tratamiento farmacológico , Complejo Vitamínico B/uso terapéutico , Anciano , Femenino , Humanos , Hidroxocobalamina/efectos adversos , Hipotensión/diagnóstico , Hipotensión/epidemiología , Hipotensión/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Vasoconstrictores/efectos adversos , Vasoplejía/diagnóstico , Vasoplejía/etiología , Vasoplejía/fisiopatología , Complejo Vitamínico B/efectos adversosAsunto(s)
Reposicionamiento de Medicamentos/tendencias , Hidroxocobalamina/uso terapéutico , Vasoplejía/tratamiento farmacológico , Complejo Vitamínico B/uso terapéutico , Reposicionamiento de Medicamentos/métodos , Exantema/inducido químicamente , Humanos , Hidroxocobalamina/efectos adversos , Hipertensión/inducido químicamente , Resultado del Tratamiento , Vasoplejía/diagnóstico , Vasoplejía/metabolismo , Complejo Vitamínico B/efectos adversosRESUMEN
CONTEXT: Hydroxocobalamin is an effective cyanide antidote. While erythema, hypertension, and chromaturia are recognized side effects, methemoglobinemia has not been reported. Methemoglobin levels are most accurately measured by co-oximetry. We describe an extensively burned patient who developed methemoglobinemia within an hour of hydroxocobalamin administration. CASE DETAILS: A 47-year old man without genetic deficiencies or abnormal hemoglobin variants presented with 61% body surface area thermal burns and grade 1 inhalation injury sustained during a tugboat engine explosion. On admission, lactate was 9.24 mmol/L, methemoglobin 1%, and carboxyhemoglobin 0.2% by blood gas analysis with co-oximetry. Despite large-volume resuscitation, lactate remained elevated (7-8 mmol/L). Intravenous hydroxocobalamin (5 g) was administered at postburn hour 19 for possible cyanide toxicity. Immediately thereafter, he became hypertensive with reflex bradycardia. Lactate decreased to 5.51 mmol/L, methemoglobin rose to 4.10%, and oxygen saturation by pulse oximetry decreased to 74-80% (despite arterial oxygen saturation of 95% by cooximetry). Methemoglobin concentration peaked at 13.40% at postburn hour 33. Methylene blue was not administered. CONCLUSIONS: Methemoglobinemia in our patient was temporally associated with hydroxocobalamin administration.
Asunto(s)
Antídotos/efectos adversos , Quemaduras por Inhalación/complicaciones , Quemaduras/complicaciones , Cianuros/envenenamiento , Hidroxocobalamina/efectos adversos , Metahemoglobinemia/inducido químicamente , Antídotos/uso terapéutico , Humanos , Hidroxocobalamina/uso terapéutico , Masculino , Persona de Mediana EdadRESUMEN
A 48-year-old woman with fire-related inhalation injury had pink urine and a pink skin. This was caused by hydroxocobalamin, which was used to treat cyanide poisoning.
Asunto(s)
Hidroxocobalamina/orina , Femenino , Humanos , Hidroxocobalamina/efectos adversos , Hidroxocobalamina/uso terapéutico , Persona de Mediana Edad , Piel/patología , Lesión por Inhalación de Humo/tratamiento farmacológicoAsunto(s)
Antídotos/efectos adversos , Cianuros/envenenamiento , Hidroxocobalamina/efectos adversos , Trastornos de la Pigmentación/inducido químicamente , Antídotos/uso terapéutico , Humanos , Hidroxocobalamina/uso terapéutico , Masculino , Persona de Mediana Edad , Trastornos de la Pigmentación/sangre , Trastornos de la Pigmentación/orina , Intoxicación/sangre , Intoxicación/orina , Lesión por Inhalación de Humo/tratamiento farmacológicoAsunto(s)
Lesión Renal Aguda/etiología , Oxalato de Calcio/efectos adversos , Hidroxocobalamina/efectos adversos , Lesión por Inhalación de Humo/tratamiento farmacológico , Adulto , Quemaduras/terapia , Oxalato de Calcio/análisis , Enfermedad Crítica/terapia , Humanos , Hidroxocobalamina/administración & dosificación , Masculino , Persona de Mediana Edad , Respiración ArtificialRESUMEN
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.
Asunto(s)
Antídotos/uso terapéutico , Medicina de Emergencia Basada en la Evidencia , Intoxicación por Gas/tratamiento farmacológico , Cianuro de Hidrógeno/toxicidad , Lesión por Inhalación de Humo/complicaciones , Centros Médicos Académicos , Algoritmos , Antídotos/efectos adversos , Biomarcadores/sangre , Terapia Combinada/efectos adversos , Árboles de Decisión , Becas , Femenino , Intoxicación por Gas/complicaciones , Intoxicación por Gas/diagnóstico , Intoxicación por Gas/terapia , Humanos , Cianuro de Hidrógeno/antagonistas & inhibidores , Hidroxocobalamina/efectos adversos , Hidroxocobalamina/uso terapéutico , Masculino , Massachusetts , Pruebas en el Punto de Atención , Lesión por Inhalación de Humo/sangre , Lesión por Inhalación de Humo/terapia , Toxicología/educación , Recursos HumanosRESUMEN
The purpose of this narrative review is to highlight insights into the importance and frequency of metabolic vitamin B12 (B12) deficiency, reasons why it is commonly missed, and reasons for the widespread but mistaken belief that treatment of B12 deficiency does not prevent stroke or improve cognitive function. Metabolic B12 deficiency is common, being present in 10%-40% of the population; is frequently missed; is easily treated; and contributes importantly to cognitive decline and stroke in older people. Measuring serum B12 alone is not sufficient for diagnosis; it is necessary to measure holotranscobalamin or functional markers of B12 adequacy such as methylmalonic acid or plasma total homocysteine. B-vitamin therapy with cyanocobalamin reduces the risk of stroke in patients with normal renal function but is harmful (perhaps because of thiocyanate accumulation from cyanide in cyanocobalamin) in patients with renal impairment. Methylcobalamin may be preferable in renal impairment. B12 therapy slowed gray matter atrophy and cognitive decline in the Homocysteine and B Vitamins in Cognitive Impairment Trial. Undiagnosed metabolic B12 deficiency may be an important missed opportunity for prevention of dementia and stroke; in patients with metabolic B12 deficiency, it would be prudent to offer inexpensive and nontoxic supplements of oral B12, preferably methylcobalamin or hydroxycobalamin. Future research is needed to distinguish the effects of thiocyanate from cyanocobalamin on hydrogen sulfide, and effects of treatment with methylcobalamin on cognitive function and stroke, particularly in patients with renal failure.
Asunto(s)
Demencia/prevención & control , Suplementos Dietéticos , Hidroxocobalamina/uso terapéutico , Accidente Cerebrovascular/prevención & control , Deficiencia de Vitamina B 12/diagnóstico , Vitamina B 12/análogos & derivados , Complejo Vitamínico B/uso terapéutico , Animales , Biomarcadores/sangre , Diagnóstico Tardío , Demencia/epidemiología , Demencia/etiología , Suplementos Dietéticos/efectos adversos , Humanos , Hidroxocobalamina/efectos adversos , Prevalencia , Riesgo , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Vitamina B 12/efectos adversos , Vitamina B 12/uso terapéutico , Deficiencia de Vitamina B 12/dietoterapia , Deficiencia de Vitamina B 12/epidemiología , Deficiencia de Vitamina B 12/fisiopatología , Complejo Vitamínico B/efectos adversosRESUMEN
OBJECTIVE: Analyses of temporomandibular joint synovial fluid using the hydroxocobalamin push-pull technique are increasingly used. However, objective complications and subjective experiences from this procedure have not been described. Firstly, this study aimed to describe discomfort and potential side-effects of this method with special emphasis on symptoms related to the arthrocentesis to be used for future patient information and Ethical Committee applications. Secondly, this study aimed to evaluate the use of cone beam computed tomography (CBCT) as control of intra-capsular cannula placement. METHODS: Twenty healthy, young adult volunteers were included. Extensive objective and subjective questionnaires were completed before and 14 days after the synovial fluid sampling. With the cannula inside the joints a CBCT was done to investigate if this procedure can be used to verify intra-capsular cannula position. RESULTS: The subjective findings: Most subjects did experience mild pain or discomfort post-operatively. In 12 of 20 subjects symptoms had resolved after 2 days and no subjects had symptoms for more than a week. The longer lasting symptoms were mainly transient joint sounds on mandibular movement. Objective findings: 14 days after the sampling mandibular protrusion had improved 1 mm, but all other objective measures were equal compared to baseline. CBCT showed a large variation in cannula position and no conclusions could be drawn from this. CONCLUSION: The hydroxocobalamin push-pull synovial fluid sampling may cause minor, transient symptoms. CBCT does not seem to provide any clinical benefits concerning the correct cannula position in relation to the upper joint compartment and disc.