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Iatrogenic pediatric hydroxocobalamin overdose.

Benjamin T Friedman1, Betty C Chen1, Andrew J Latimer1

  • 1University of Washington, Department of Emergency Medicine, United States of America.

The American Journal of Emergency Medicine
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This case report details a pediatric hydroxocobalamin overdose, finding only expected side effects like skin and urine discoloration. The child recovered fully, showing no serious complications from the excess dose for cyanide toxicity treatment.

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Area of Science:

  • Emergency Medicine
  • Toxicology
  • Pediatrics

Background:

  • Hydroxocobalamin is a first-line empiric treatment for smoke inhalation and cyanide toxicity.
  • Limited data exist on hydroxocobalamin toxicity, especially in pediatric populations.

Observation:

  • A 3-year-old girl received an intentional overdose of hydroxocobalamin (373 mg/kg) for suspected cyanide toxicity post-fire rescue.
  • The patient presented with chromaturia and erythroderma, but no burns.
  • She was extubated within 4 hours and discharged the next day with resolving erythroderma.

Findings:

  • This is the first reported case of iatrogenic pediatric hydroxocobalamin overdose.
  • Chromaturia and erythroderma are known side effects, even at therapeutic doses.
  • No complications were attributed to the excess hydroxocobalamin; transient bradycardia was likely due to other interventions.

Implications:

  • Hydroxocobalamin appears safe even at doses significantly exceeding recommendations in pediatric cases of smoke inhalation.
  • Further research is needed to establish definitive pediatric dosing and toxicity profiles.
  • This case supports the empiric use of hydroxocobalamin in pediatric smoke inhalation patients with suspected cyanide poisoning.