A case of accidental exposure of a patient undergoing hemodialysis to a sodium hypochlorite solution is reported. A 61-year-old woman was completing a hemodialysis treatment when routine cleaning of the hemodialysis machine was started. Approximately two liters of undiluted sodium hypochlorite cleaning solution (Chlorox) was added to the dialysis bath, soaking the membrane fibers. For less than two minutes the Chlorox-soaked membrane was in contact with the blood returning to the patient. This accident led to massive hemolysis, hyperkalemia, cyanosis, and cardiopulmonary arrest. Hemolysis may have been caused by the hypertonic solution, rapid exothermic protein degradation, alkaline degradation, or another mechanism. The sudden rise and fall in the concentrations of serum electrolytes and subsequent hyperkalemia was the most probable cause for the cardiac arrest. Cardiopulmonary resuscitation was started, the patient was intubated, given oxygen, sodium bicarbonate, atropine, dopamine, and isoproterenol. Sodium thiosulfate 5 g was administered by a nasogastric tube approximately 25 minutes after the cardiac arrest as a neutralizing reducing agent. The patient's condition stabilized, and she recovered after a week of hospitalization. Cleaning solutions used in the routine cleaning of hemodialysis machinery represent potentially toxic agents. Hemodialysis procedures should ensure that cleaning and sterilizing solutions cannot accidentally come into contact with a dialysis machine that is still connected to the patient.

Electrolytes↗

PubMed1980

Thiopental anaphylaxis and reagin involvement.

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Anaphylaxis↗

PubMed1978

Gentamicin-cephalothin drug reaction.

A case report describing the occurrence of nephrotoxicity in a 26-year-old black male with sickle cell anemia after concurrent i.v. administration of gentamicin sulfate and cephalothin sodium is presented. Cephalothin 1 g.i.v. every six hours was given for three days for a Klebsiella infection demonstrated by urine and blood culture to be cephalosporin sensitive. Cephalothin was then discontinued and gentamicin, after an i.v. loading dose of 2.6 mg/kg, was given for 14 days in a dosage of 1.3 mg/kg every eight hours. After cultures of pus aspirated from the right thigh demonstrated Klebsiella, 2 g of cephalothin was administered i.v. every six hours and gentamicin sulfate was discontinued. Gentamicin therapy was reinstituted two days later, at a dosage of 5 mg/kg/day. The gentamicin-cephalothin therapy was continued for nine days. The gentamicin dosage interval was increased from every eight to every 16 hours when serum creatinine and gentamicin levels became elevated. Gentamicin was discontinued entirely two days later because serum gentamicin levels were not decreasing. Previous case reports and studies of nephrotoxicity associated with concurrent gentamicin-cephalothin therapy are reviewed. Pharmacists should be alert to the possible increased incidence of nephrotoxicity occurring with concurrent genticin-cephalothin therapy.

Adult↗