Article Text

Download PDFPDF
Intraosseous administration of hydroxocobalamin after enclosed structure fire cardiac arrest
  1. Joshua Mastenbrook1,
  2. Rachel Zamihovsky2,
  3. Nathan Brunken1 and
  4. Thomas Olsen1
  1. 1Department of Emergency Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
  2. 2Department of Student Affairs, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
  1. Correspondence to Dr Joshua Mastenbrook; Joshua.Mastenbrook{at}


Smoke inhalation is the most common cause of acute cyanide poisoning in the developed world. Hydroxocobalamin is an antidote for cyanide poisoning. There is little published about human intraosseous antidote administration. We present a case of intraosseous hydroxocobalamin administration in an adult smoke inhalation victim, found in cardiac arrest inside her burning manufactured home. Return of spontaneous circulation was achieved after 20 min of cardiopulmonary resuscitation. Five grams of hydroxocobalamin were subsequently given intraosseously. On hospital arrival, patient was found to have a respiratory-metabolic acidosis. She had red-coloured urine without haematuria, a known sequela of hydroxocobalamin administration. Patient’s neurological status deteriorated, and she died 4 days after admission. This case highlights that intraosseously administered hydroxocobalamin seems to adequately flow into the marrow cavity and enter the circulatory system despite the non-compressible glass antidote vial. This appears to be only the second reported human case of intraosseous hydroxocobalamin administration.

  • emergency medicine
  • prehospital
  • resuscitation
  • poisoning
  • toxicology

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors All authors contributed significantly to the development of this case report and accepted the current submitted version of the manuscript. JM, RZ, NB and TO assisted with literature searches and article reviews. JM, NB and TO obtained the data and created the abstract. NB and TO created the initial draft of the manuscript in collaboration with JM. JM provided multiple draft revisions. RZ and JM transformed the manuscript into the correct format for BMJ Case Reports, which required additional content to be added. JM and RZ revised the initial manuscript submitted to BMJ Case Reports, following receipt of comments from the peer review process.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Next of kin consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.