Blood Leak Alarms With Hydroxocobalamin Administration

Calcium channel blocker overdose can be difficult to manage and sometimes requires the use of off-label medications, such as hydroxocobalamin, that may potentially interfere with hemodialysis therapy due to dialysate discoloration. We report a case of an adult patient who presented following an overdose of a dihydropyridine calcium channel blocker, and developed refractory vasoplegic shock. Management included the use of hydroxocobalamin, methylene blue, and hemodialysis. Hemodialysis treatment was interrupted due to recurrent false blood leak alarms triggered by dialysate discoloration due to hydroxocobalamin administration. This was ultimately resolved by switching the type of hemodialysis machines. Herein, we discuss the causes and solutions of false blood leak alarms in the treatment of calcium channel blocker overdose. We also elaborate on the mechanism of false blood leak alarms with different types of dialysis machines, which machines are likely/ unlikely to be triggered by false blood leak alarms and propose an algorithmic approach on how to overcome them.