Elevated Serum Cobalt Concentrations Associated With Hydroxocobalamin Administration for Refractory Vasoplegia

Abstract

Abstract Cobalt is a trace mineral important for normal metabolism. Elevated circulating cobalt concentrations may be seen after toxic ingestions, occupational exposure, and wear of metallic implants. We report a case of markedly elevated serum cobalt levels attributed to administration of hydroxocobalamin as a treatment for refractory hypotension. While excessive cobalt may be potentially toxic, the clinical significance of elevated serum cobalt associated with hydroxocobalamin administration remains to be elucidated. While hydroxocobalamin is an emerging therapy in a clinician's arsenal in treatment of vasodilatory shock, this case illustrates the need for a heightened level of awareness among clinicians for potential adverse effects and abnormal laboratory findings associated with this therapy.