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Effect of Hydroxocobalamin on Surface Oximetry in Nonexposed Humans

  • Brian V. Cashin (a1), Aaron G. Matlock (a1), Chris Kang (a1), Penny S. Reynolds (a2) and Brandon K. Wills (a2) (a3)...

Abstract

Introduction

The newer cyanide antidote, hydroxocobalamin, due to its pigmentation, has been found to cause interferences in some laboratory assays. Co-oximetry may also be affected by hydroxocobalamin, leading to false elevations in hemoglobin concentration, methemoglobin, carboxyhemoglobin, and false decreases in oxyhemoglobin. The Masimo Radical-7 is a medical device that performs noninvasive oximetry and estimates hemoglobin (Hb) concentration and percent carboxyhemoglobin (COHb), methemoglobin (MetHb), and oxyhemoglobin saturation (O2Hb).

Study Objectives

The study sought to determine the effect of hydroxocobalamin on noninvasive measurement of hemoglobin indices using the Masimo Radical-7 monitor.

Methods

Seven asymptomatic volunteers who were unexposed to cyanide had baseline heart rate (HR), blood pressure (BP), and oximeter measurements recorded followed by an infusion of five grams of hydroxocobalamin over 15 minutes. The above parameters were subsequently recorded at: 5, 10, 15, 30 and 60 minutes post infusion. Data were analyzed by calculating the area under the curve (AUC) for each variable and comparing the results to expected values by paired t tests. Expected AUC values were calculated by extrapolating baseline values across the entire time period.

Results

The mean differences from baseline values with 95% confidence intervals and t tests of mean difference were: SBP: 11 mm Hg (95% CI, 0-22; P = .051); HR: -9 (95% CI, -15 to -3; P = .01); Hb: -0.1 (95% CI, -0.7 to 0.4; P = .57); O2Hb: 0 g/dL (95% CI, -1 to 1; P = .41); COHb: -1 (95% CI, -3 to 1; P = .25); MetHb: -0.2 (95% CI, -0.3 to 0; P = .03).

Discussion

After infusion of hydroxocobalamin there was a significant elevation of systolic blood pressure and decrease in heart rate. There were no significant differences in Hb, O2Hb, and COHb. Although percent methemoglobin concentrations were statistically lower, the authors feel this difference is of trivial clinical significance.

Conclusion

The administration of hydroxocobalamin does not significantly impact noninvasive oximetry.

CashinB, MatlockA, KangC, ReynoldsP, WillsB. Effect of Hydroxocobalamin on Surface Oximetry in Nonexposed Humans. Prehosp Disaster Med. 2013;28(4):1-3.

Copyright

Corresponding author

Correspondence: Brandon Wills, DO, MS Associate Professor, VCU Medical Center 600 East Broad St. Richmond, VA 23219 USA E-mail bwills@mcvh-vcu.edu

References

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1.Dart, RC. Hydroxocobalamin for acute cyanide poisoning: new data from preclinical and clinical studies; new results from the prehospital emergency setting. Clin Toxicol (Phila). 2006;44(Suppl 1):1-3.
2.Fortin, JL, Giocanti, JP, Ruttimann, M, et al. Prehospital administration of hydroxocobalamin for smoke inhalation-associated cyanide poisoning: 8 years of experience in the Paris Fire Brigade. Clin Toxicol (Phila). 2006;44(Suppl 1):37-44.
3.Borron, SW, Baud, FJ, Barriot, P, et al. Prospective study of hydroxocobalamin for acute cyanide poisoning in smoke inhalation. Ann Emerg Med. 2007;49(6):794-801, 801 e791-792.
4. Cyanokit [package insert]. Napa, California: Dey, L.P.; 2007.
5.Beaudeux, JL, Flourie, F, Peynet, J, et al. Hydroxocobalamin and sodium thiosulfate interfere negatively with measurement of creatine kinase activity. Clin Chem. 1994;40(11 Pt 1):2120-2121.
6.Curry, SC, Connor, DA, Raschke, RA. Effect of the cyanide antidote hydroxocobalamin on commonly ordered serum chemistry studies. Ann Emerg Med. 1994;24(1):65-67.
7.Vest, P, Renaudeau, C, Tellal, S, et al. Interference of hydroxocobalamin treatment on commun biochemical determinations [in French]. Ann Biol Clin (Paris). 2002;60(1):57-64.
8.Denninghoff, K, Walter, FG, Langa, AJ, et al. Spectrophotometry of hydroxocobalamin and hemoglobin reveals production of an unanticipated methemoglobin variant. Clin Toxicol (Phila). 2008;46(6):545-550.
9.Lee, J, Mukai, D, Kreuter, K, et al. Potential interference by hydroxocobalamin on cooximetry hemoglobin measurements during cyanide and smoke inhalation treatments. Ann Emerg Med. 2007;49(6):802-805.

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Effect of Hydroxocobalamin on Surface Oximetry in Nonexposed Humans

  • Brian V. Cashin (a1), Aaron G. Matlock (a1), Chris Kang (a1), Penny S. Reynolds (a2) and Brandon K. Wills (a2) (a3)...

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