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Elevated hydrogen sulfide (HIn adults with septic shock, is comparing high-dose IV hydroxocobalamin with placebo feasible?We conducted a phase 2 single-center, double-blind, allocation-concealed, placebo-controlled, parallel-group pilot randomized controlled trial comparing high-dose IV hydroxocobalamin with placebo in critically ill adults with septic shock. Patients meeting Sepsis 3 criteria were randomized 1:1 to receive a single 5-g dose of high-dose IV hydroxocobalamin or equivalent volume 0.9% saline solution as placebo. The primary outcome was study feasibility (enrollment rate, clinical and laboratory compliance rate, and contamination rate). Secondary outcomes included between-group differences in plasma HTwenty patients were enrolled over 19 months, establishing an enrollment rate of 1.05 patients per month. Protocol adherence rates were 100% with zero contamination. In the high-dose IV hydroxocobalamin group, compared to placebo, there was a greater reduction in vasopressor dose between randomization and postinfusion (-36% vs 4%, P .001) and randomization and 3-h postinfusion (-28% vs 10%, P = .019). In the high-dose IV hydroxocobalamin group, the plasma HThis pilot trial established favorable feasibility metrics. Consistent with the proposed mechanism of benefit, high-dose IV hydroxocobalamin compared with placebo was associated with reduced vasopressor dose and HClinicalTrials.gov; No.: NCT03783091; URL: www.gov.

Synthetic cannabinoids (SCBs) are a popular new class of designer drugs. In 2018, the Centers for Disease Control and Prevention advised that illicit products containing SCB compounds were laced with brodifacoum (BDF), a highly potent superwarfarin easily purchased as a rodenticide. Multiple outbreaks of bleeding from BDF exposure have since been reported. Patients with BDF toxicity present with bleeding ranging from mild epistaxis to life-threatening hemorrhage. Given the increasing popularity of SCBs as recreational drugs, outbreaks from BDF exposure are likely to continue, presenting a public health risk. The nurse practitioner has a vital role in the complex, ongoing management of this patient population.