Abstract: PUB187
Misleading Dialysate Discoloration after Vitamin B12 Infusion: A Case Report
Session Information
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Ebrahimi, Niloufar, Loma Linda University Medical Center, Loma Linda, California, United States
- Norouzi, Sayna, Loma Linda University Medical Center, Loma Linda, California, United States
- Abdi Pour, Amir, Loma Linda University Medical Center, Loma Linda, California, United States
Introduction
Hemodialysis (HD) blood leaks through the dialyzer, may lead to hemolysis, and blood loss and potentially cause hemorrhagic shock in patients undergoing HD. A semipermeable membrane separates blood from the dialysate in the HD machine circuit. An alarm is triggered when blood leaks through the dialyzer membrane and blood flow ceases. Vitamin B12 is easily removed by HD and may appear in the dialysate, causing a red discoloration. Consequently, the dialysate color change can falsely trigger the dialysis machine's blood leak alarm.
Case Description
A 75-year-old Hispanic male with a history of type 2 diabetes mellitus, hypertension, chronic kidney disease stage 3, and chronic systolic heart failure was admitted with acute respiratory failure due to fluid overload. His hospitalization course was complicated by cardiac tamponade, cardiogenic shock, upper gastrointestinal bleeding, and oliguric acute kidney injury requiring dialysis. The patient was initially started on continuous renal replacement therapy (CRRT) and, upon hemodynamic status improvement, was transitioned to intermittent HD. The patient had received a vitamin B12 infusion while in shock, which triggered a false blood leak alarm on the HD machine in two separate sessions. HD was terminated, and a dialysate test confirmed no evidence of blood. The serum vitamin B12 was measured > 2000 pg/mL. The patient remained in kidney failure, necessitating dialysis; therefore, CRRT was resumed with red-color effluent (Figure 1).
Discussion
The dialysate outflow line sensors on HD machines are designed to detect blood, reducing the risk of potential complications from a blood leak. False blood alarms may occur due to non-blood contaminants. Administering high doses of vitamin B12 can trigger blood leak alarms, leading to dialysis treatment termination.
CRRT red-colored effluent