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Effect of Hydroxocobalamin on Surface Oximetry in Nonexposed Humans

Published online by Cambridge University Press:  01 May 2013

Brian V. Cashin Jr. ,
Aaron G. Matlock ,
Chris Kang ,
Penny S. Reynolds  and
Brandon K. Wills
Brian V. Cashin Jr.
Affiliation:
Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, Washington USA
Aaron G. Matlock
Affiliation:
Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, Washington USA
Chris Kang
Affiliation:
Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, Washington USA
Penny S. Reynolds
Affiliation:
Department of Emergency Medicine, VCU Medical Center, Richmond, Virginia USA
Brandon K. Wills*
Affiliation:
Department of Emergency Medicine, VCU Medical Center, Richmond, Virginia USA Virginia Poison Center, Richmond, Virginia USA
*
Correspondence: Brandon Wills, DO, MS Associate Professor, VCU Medical Center 600 East Broad St. Richmond, VA 23219 USA E-mail bwills@mcvh-vcu.edu
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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.

Keywords

co-oximetrycyanidehydroxocobalamin
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 28 , Issue 4 , August 2013 , pp. 367 - 369
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2013 

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