Annals of Emergency Medicine
Volume 49, Issue 6 , Pages 802-805, June 2007

Potential Interference by Hydroxocobalamin on Cooximetry Hemoglobin Measurements During Cyanide and Smoke Inhalation Treatments

  • Jangwoen Lee, PhD

      Affiliations

    • Laser Microbeam and Medical Program, Beckman Laser Institute, University of California, Irvine, CA
    • ,
  • David Mukai, BS

      Affiliations

    • Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Irvine, CA.
    • ,
  • Kelly Kreuter, MA

      Affiliations

    • Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Irvine, CA.
    • ,
  • Sari Mahon, PhD

      Affiliations

    • Laser Microbeam and Medical Program, Beckman Laser Institute, University of California, Irvine, CA
    • ,
  • Bruce Tromberg, PhD

      Affiliations

    • Laser Microbeam and Medical Program, Beckman Laser Institute, University of California, Irvine, CA
    • ,
  • Matthew Brenner, MD

      Affiliations

    • Laser Microbeam and Medical Program, Beckman Laser Institute, University of California, Irvine, CA
    • Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Irvine, CA.
    • Corresponding Author InformationAddress for correspondence: Matthew Brenner, MD, 101 The City Drive South, Bldg 53, Rm 119, Rt 81, University of California Irvine, Orange, CA 92037-0976; 714-456-5150, fax 858-657-7075

Received 5 June 2006; received in revised form 10 November 2006; accepted 15 November 2006. published online 08 January 2007.

Study objective

Concentrated aqueous solutions of hydroxocobalamin (OHCob) are administered intravenously for cyanide poisoning victims, many of whom also have concurrent smoke inhalation. Because of its intense light absorbance in visible wavelengths (absorption peak at 532 nm), we investigate potential interference effects of OHCob on total hemoglobin concentration (tHb), carboxyhemoglobin (COHb), methemoglobin (MetHb), and oxyhemoglobin (Hb-O2) cooximetry measurement values in blood.

Methods

In vivo cooximetry measurements were conducted with 3 specific pathogen-free white New Zealand rabbits (3.80±0.21 kg) during the intravenous infusion of OHCob (625 mg during a 100-minute period). Resultant changes in tHb, Hb-O2, COHb, and MetHb values were measured and correlated with respect to estimated in vivo OHCob concentrations. In vitro measurements were conducted with rabbit blood to confirm in vivo measurements.

Results

The introduction of OHCob clearly interfered with the cooximetry measurements of each of the hemoglobin component fractions in whole blood and resulted in altered measurement values from the baseline values. The presence of OHCob in blood interferes with cooximetry measurements of COHb, MetHb, and Hb-O2. The increase in measured COHb fraction with increasing concentrations of OHCob was most notable.

Conclusion

The presence of OHCob in blood interferes with cooximetry measurements of COHb, MetHb, and Hb-O2. These effects need to be considered during OHCob treatment of cyanide poisoning, particularly in smoke inhalation victims with potential for concurrent carbon monoxide exposure, because it may lead to potentially erroneous reported COHb levels.

To access this article, please choose from the options below

Login to an existing account or Register a new account.

  • Purchase this article for 31.50 USD (You must login/register to purchase this article)

    Online access for 24 hours. The PDF version can be downloaded as your permanent record.

  • Subscribe to this title

    Get unlimited online access to this article and all other articles in this title 24/7 for one year.

  • Claim access now

    For current subscribers with Society Membership or Account Number.

  • Visit SciVerse ScienceDirect to see if you have access via your institution.
 

 Supervising editor: Stephen R. Thom, MD, PhDAuthor contributions: JL, BT, and MB conceived the study and obtained the research funding. JL, DM, SM, and MB designed and supervised the conduct of the experiments and obtained study approvals. JL, DM, and KK conducted the experiments and managed data. JL drafted the article. SM and MB contributed substantially to its revision and finalization. MB takes responsibility for the paper as a whole.Funding and support: This work is based on research sponsored by the Air Force Research Laboratory, under agreement number FA9550-04-1-0101. The US government is authorized to reproduce and distribute reprints for governmental purposes, notwithstanding any copyright notation thereon. This work is also supported by Laser Microbeam and Medical Program, Beckman Laser Institute, University of California, Irvine, grant No. 445574-30133.Publication dates: Available online January 8, 2007.Reprints not available from the authors.

PII: S0196-0644(06)02540-6

doi:10.1016/j.annemergmed.2006.11.016

Refers to article:

  • Is Hydroxocobalamin Safe and Effective for Smoke Inhalation? Searching for Guidance in the Haze

    Andrew R. Erdman
    Annals of Emergency Medicine June 2007 (Vol. 49, Issue 6, Pages 814-816)

Annals of Emergency Medicine
Volume 49, Issue 6 , Pages 802-805, June 2007

Article Tools

* Image Usage & Resolution