![]() Hydroxocobalamin is currently the preferred therapy for suspected cyanide toxicity due to its favorable side-effect profile compared to the three agent antidote kit. Drawbacks to this treatment regimen include unpredictable induction of methemoglobinemia, vasodilation, and slow onset of action. Prior to 2006, the only available treatment for cyanide toxicity was the three-agent cyanide antidote kit which was comprised of sodium thiosulfate, amyl nitrite, and sodium nitrite. ![]() Of the approximately 3,400 fire-related deaths in the Unites States annually, 60-80% are thought to be associated with inhalation injury. Inhalation injury occurs in up to 30% of all fire-related injuries. Further studies on the relationship between the administration of hydroxocobalamin and the development of AKI and in-hospital mortality are warranted.Ĭyanide poisoning is a leading cause of death in smoke-related inhalation injury. One-third of patients who received hydroxocobalamin after ICU admission died during their hospital stay. Conclusions: Most patients who receive at least 1 dose of hydroxocobalamin after ICU admission developed AKI within the first 72 hours, with 42.8% of patients requiring CRRT during the initial resuscitation period. Ten (28.9%) patients died during their hospital stay. The average duration of mechanical ventilation was 11 ± 7 days. The average time to carboxyhemoglobin level less than 3% was 3.4 ± 2.6 hours. One patient had a carboxyhemoglobin level greater than 10% on admission and 4 patients had a carboxyhemoglobin level greater than 3% on admission. On average, lactate clearance occurred in 34.6 hours 11 (31.4%) patients did not clear lactate within 72 hours. Twenty one (60%) patients required CRRT at some point during their hospital stay, with 42.8% of patients being initiated on CRRT during the resuscitation period. Twenty two (63%) patients who received hydroxocobalamin developed an acute kidney injury (AKI) during the first 72 hours of admission, with the average time from burn to AKI being approximately 20 hours. The median fluid resuscitation requirement was 7.4 mL/kg/%TBSA (IQR 4.6, 12.7). Twenty nine (82.9%) patients who received hydroxocobalamin in the ICU were diagnosed with inhalation injury via bronchoscopy. Results: Thirty five patients received at least 1 dose of hydroxocobalamin after ICU admission 31 patients received 1 dose and 4 patients received 2 doses. Development of acute kidney injury (AKI) as per the AKIN criteria, as well as need for and duration of continuous renal replacement therapy (CRRT) were also collected. Data were collected from the electronic medical record and included demographic information, number of hydroxocobalamin doses administered, burn size (%TBSA), presence and grade of inhalation injury, lactate levels during the first 72 hours of hospitalization, carboxyhemoglobin levels, duration of mechanical ventilation, and in-hospital mortality. Patients who received hydroxocobalamin in the pre-ICU or pre-hospital setting were not included. Patients were included if they received hydroxocobalamin after burn ICU admission. All patients admitted to the burn ICU at a large, government medical center between Jand Apwere considered for inclusion. Methods: This was a retrospective chart review that was approved by our institution’s research and regulatory compliance division as a performance improvement (PI) project (H-19-019nr). ![]() We hypothesized that there is a relationship between the administration of hydroxocobalamin and the development of acute kidney injury (AKI). ![]() Objectives: The aim of this project was to describe the population in which hydroxocobalamin was administered and assess clinical outcomes such as mortality and need for renal replacement therapy. However, over the last several years, the safety of hydroxocobalamin has been called into question by case reports of crystalline nephropathy and interference with renal replacement therapies. Hydroxocobalamin is generally considered safe. Background: Hydroxocobalamin is frequently administered to patients after injures sustained during structure fires or fires in enclosed spaces, prior to confirming inhalation injury with bronchoscopy.
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