hydroxocobalamin (vit B12) / Generic mfg. - LARVOL DELTA

Vasoplegia and cardiopulmonary bypass: role of oxidation-reduction dysregulation as a mechanism and therapeutic target. (PubMed, Br J Anaesth) - "Use of hydroxocobalamin (vitamin B-12) is a novel approach to increase perfusion pressure...Vitamin B-12 is an antioxidant that protects proteins, DNA, and lipids from attack by the unpaired electrons of free radicals. The observations that vitamin B-12 and other antioxidants, including ascorbic acid and methylene blue, all partially treat vasoplegia should signal to cardiac teams that focused research on the effects of oxidation-reduction dysregulation by inflammation needs further exploration."

Journal • Hypotension • Inflammation

Kidney failure trajectories and sub phenotypes in severe burn patients. (PubMed, Anaesth Crit Care Pain Med) - "Primary AKI represents the most severe renal complication post-burn, while secondary injuries reflect later complications such as infection, hemorrhagic complications, or ARDS."

Journal • Acute Kidney Injury • Acute Respiratory Distress Syndrome • Addiction (Opioid and Alcohol) • Alzheimer's Disease • Cardiovascular • CNS Disorders • Dementia • Hematological Disorders • Infectious Disease • Nephrology • Renal Disease

High-Dose Hydroxocobalamin in Liver Transplantation: Effect on Blood Pressure and Risk of AKI (KIDNEY WEEK 2025) - "Given reports of oxalate nephropathy and AKI in burn patients, this mechanism may also be at play here. This off-label use of HD-B12 warrants further investigation."

Acute Kidney Injury • Nephrology • Renal Disease • Solid Organ Transplantation • Transplantation

Seeing Red: A Case of Hydroxocobalamin-Induced Blood Leak Alarm in Hemodialysis (KIDNEY WEEK 2025) - "Because these systems do not interpret dialysate color, they remain unaffected by chromogenic substances like hydroxocobalamin, enabling uninterrupted renal replacement therapy despite the vivid discoloration. As the use of hydroxocobalamin expands, this case emphasizes the need for heightened awareness of machine–patient interactions to avoid unwarranted treatment interruptions."

Clinical • Acute Kidney Injury • Fibrosis • Hepatology • Immunology • Nephrology • Renal Disease

All That Is Red Is Not Blood: Reddish Discoloration of Dialysis Ultrafiltrate in a Heart Transplant Recipient (KIDNEY WEEK 2025) - "With increasing use of hydroxocobalamin in vasoplegic states and as an antidot in cyanide poisoning, the treating clinicians should be aware of this phenomenon. Reddish discoloration of the ultrafiltrate"

Clinical • Acute Kidney Injury • Cardiomyopathy • Cardiovascular • Chronic Kidney Disease • Diabetes • Diabetic Nephropathy • Hematological Disorders • Hypertension • Metabolic Disorders • Nephrology • Renal Disease • Transplantation • Type 2 Diabetes Mellitus

The importance of high doses of hydroxocobalamin in Brazilian cblC patients (SSIEM 2023) - No abstract available

Clinical

The importance of high doses of hydroxocobalamin in Brazilian cblC patients (SSIEM 2023) - No abstract available

Clinical

The importance of high doses of hydroxocobalamin in Brazilian cblC patients (SSIEM 2023) - No abstract available

Clinical

The importance of high doses of hydroxocobalamin in Brazilian cblC patients (SSIEM 2023) - "Clinical improvement with dhdp-OHCbl was presented by all patients. The active leadership of patients’ association and expert doctors was essential to avoid the cessation of production of the p-OHCbl and to obtain the specific cblC indication in the package leaflet in Brazil."

Clinical • CNS Disorders • Epilepsy

Clinical, biochemical and molecular features of a cohort of 8 patients with inherited disorders of vitamin B12 metabolism in a metabolic reference center (SSIEM 2023) - "CblC: P1 and P2, pré-newborn screening (NBS), had an early and severe presentation evolving to multiorgan failure and death. P3 was asymptomatic at NBS with an excellent evolution except for nystagmus and retinitis pigmentosa. P4 presented at 19Y with an atypical hemolytic uremic syndrome and is presently on hemodialysis."

Clinical • Anemia • Atypical Hemolytic Uremic Syndrome • CNS Disorders • Complement-mediated Rare Disorders • Developmental Disorders • Epilepsy • Genetic Disorders • Hematological Disorders • Inherited Retinal Dystrophy • Metabolic Disorders • Nephrology • Ocular Inflammation • Ophthalmology • Retinal Disorders • Retinitis Pigmentosa

Pre-symptomatic diagnosis and optimized treatment lead to improved outcomes in early onset cobalamin C deficiency. (SSIEM 2023) - P | "Optimal dosing of hydroxocobalamin (OHCbl) and betaine supplementation is debated, and disease progression occurs despite treatments... Newborn screening coupled with optimized dietary and cofactor therapy can improve the natural history of infantile cblC deficiency. Whether early high-dose OHCbl therapy can mitigate cblC maculopathy will require further study."

Age-related Macular Degeneration • CNS Disorders • Developmental Disorders • Epilepsy • Genetic Disorders • Macular Degeneration • Mental Retardation • Metabolic Disorders • Ophthalmology • Retinal Disorders

Imerslund-Gräsbeck syndrome presenting with a 12-year history of intermittent proteinuria and anemia: a case from the Middle East. (PubMed, BMC Pediatr) - "This case emphasizes the importance of considering IGS in children and adolescents with unexplained macrocytic anemia and proteinuria, particularly in the Middle East where the condition is underdiagnosed. Early recognition and lifelong vitamin B12 supplementation are critical to prevent irreversible complications such as neurological deficits, developmental delay, and growth impairment."

Journal • Anemia • Anorexia • Developmental Disorders • Fatigue • Hematological Disorders • Infectious Disease • Renal Disease • Thrombocytopenia • AMN

ECMO: Beating the Block on a Failing Heart (AHA 2025) - "Case ReportA 26-year-old man with HTN and MDD presented via EMS with 1 day of myalgias, abdominal pain, and hypotension requiring fluid and epinephrine infusion en route after ingesting ~350 mg of amlodipine 2 days prior...Glucagon, intralipid, activated charcoal, hydroxocobalamin, and calcium gluconate were given under guidance of toxicology...Amlodipine is the most common d-CCB involved in poisoning and associated with a high mortality due to prolonged vasoplegia resistant to fluid resuscitation and vasopressors. We present a unique case of a young male with d-CCB toxicity, resulting in hemodynamic circulatory collapse with cardiac arrest successfully supported with early peripheral VA-ECMO.This case report highlights the utility of peripheral VA-ECMO in mixed distributive/cardiogenic shock from d-CCB intoxication resistant to medical therapy, suggesting that d-CCB intoxication can be managed with early initiation of peripheral VA-ECMO as opposed to other reports of..."

Cardiovascular • Hypotension • Musculoskeletal Pain

Discoloration source and control of a biotechnological drug product manufactured using a high titer production process. (PubMed, J Pharm Sci) - "The current study highlights the complexity and potential challenges in the development of a high titer production process, where increased concentrations of cell culture components in the production bioreactor can result in unexpected component interactions, presenting potential risks to product quality. The comprehensive approach described in this study presents a systemic means for root cause analysis of an OOS result and also a sound strategy for developing controls for product quality attributes such as process impurities."

Journal

Vasodilatory Shock-From Initial Resuscitation to Rescue Therapies: Narrative Review and Considerations for Critical Care Transport. (PubMed, Air Med J) - "Finally, emerging treatments may be considered for refractory vasodilatory shock, including angiotensin II, methylene blue, and hydroxocobalamin. Overall, this review presents an evidence-based tiered approach to management of refractory vasodilatory shock in critical care transport."

Journal • Review • Cardiovascular • Critical care • Infectious Disease • Septic Shock

MANAGEMENT OF VASOPLEGIC SHOCK IN CLONAZEPAM OVERDOSE AND ALCOHOL ABUSE: USE OF HYDROXOCOBALAMIN AND AVOIDANCE OF METHYLENE BLUE DUE TO SEROTONIN SYNDROME RISK (CHEST 2025) - "In this report, we describe a case of clonazepam overdose-induced vasoplegic shock with inadequate response to fluids, norepinephrine, vasopressin, hydrocortisone, and angiotensin II...He was treated with phenobarbital and placed on the Clinical Institute Withdrawal Assessment (CIWA) protocol... This case contributes to the growing body of evidence supporting the use of hydroxocobalamin in vasoplegic shock and highlights the need for further research into optimal management strategies for this complex condition."

Addiction (Opioid and Alcohol) • Depression • Hypotension • Mood Disorders • Suicidal Ideation

DELAYED DIAGNOSIS OF CYANIDE TOXICTY: CLINICAL CHALLENGES AND DIAGNOSTIC LIMITATIONS IN THE TREATMENT OF POISONING (CHEST 2025) - "Cyanide toxicity inhibits cellular respiration and causes rapid development of severe lactic acidosis, encephalopathy, and cardiovascular collapse. We highlight our case to illustrate that patients with cyanide toxicity present with many non-specific symptoms which may mimic other clinical conditions, and that many limitations with testing exist hindering prompt identification and treatment of this rapidly fatal condition. Furthermore, delayed diagnosis can create further treatment dilemma as the use of hydroxocobalamin is limited in patients undergoing hemodialysis."

Clinical • Cardiovascular • CNS Disorders • Epilepsy • Hypotension • Metabolic Disorders • Nephrology • Renal Disease

FULMINANT CYANIDE TOXICITY FROM APRICOT KERNEL INGESTION: RAPID REVERSAL WITH HYDROXOCOBALAMIN THERAPY (CHEST 2025) - "This case underscores the critical need for early recognition and treatment of cyanide poisoning, particularly from food-based sources. Prompt hydroxocobalamin administration, aggressive resuscitation, and renal support were key to survival. The rapid resolution of metabolic derangements and neurologic function reinforces the life-saving potential of timely intervention."

Acute Kidney Injury • Anemia • CNS Disorders • Depression • Hematological Disorders • Metabolic Disorders • Nephrology • Psychiatry • Renal Disease • Respiratory Diseases • Thrombocytopenia

UNUSUAL METABOLIC PROTEINURIA IN A CHILD (ESPN 2025) - "In light of this finding, treatment with hydroxocobalamin (1 mg/day), betaine, and folate (up to 10 mg four times/day) has been initiated and we observed a consistent reduction of proteinuria... Cianocobalamin C defect is a disorder in the intracellular metabolism of vitamin B12 which involves a deficiency in the release of cobalamin from cyanocobalamin or alkylcobalamin due to the MMACHC gene mutation. Clinical presentation exhibits a heterogeneous phenotype related to the age of onset (early or late) with multisystem involvement. The manifestations include: vomiting, poor growth, psychomotor delay, megaloblastic anemia, atrophic glossitis, progressive encephalopathy, and proteinuria."

Clinical • Anemia • CNS Disorders • Genetic Disorders • Glomerulonephritis • Hematological Disorders • Lupus Nephritis • Metabolic Disorders • Nephrology • Ophthalmology • Pediatrics • Renal Disease • MTHFR

ATYPICAL GLOMERULONEPHROPATHY IN TEENAGER DUE TO COBALAMIN C DEFICIENCY (ESPN 2025) - "A treatment by high dose hydroxocobalamin, betaine and levocarnitine was introduced at this moment. Through this case report we want to raise awareness about the probable existence of other kidney injuries of cobalamin C deficiency in teenagers, different from thrombotic microangiopathy. Here we describe an adolescent with atypical glomerulopathy at the crossroad of HUS and membranoproliferative glomerulonephritis."

Anemia • Cardiovascular • CNS Disorders • Glomerulonephritis • Hematological Disorders • Lupus Nephritis • Nephrology • Psychiatry • Pulmonary Arterial Hypertension • Renal Disease • Schizophrenia • Thrombocytopenia • HP

Recurrent Pulmonary Hemorrhage and Cyanide Toxicity in a Patient with Decompensated Heart Failure requiring VA ECMO (ASA 2025) - "She developed encephalopathy, tachycardia, lactic acidosis, and pulmonary edema after which she was intubated and received hydroxocobalamin given concern for cyanide toxicity. She developed acute hypoxemia and hemoptysis and underwent serial bronchoscopies for persistent pulmonary hemorrhage which demonstrated significant clot burden causing airway obstruction. The patient was transitioned to comfort care measures given deteriorating clinical status precluding LVAD/heart transplant after which the patient expired with family at bedside."

Clinical • Cardiovascular • CNS Disorders • Congestive Heart Failure • Heart Failure • Hematological Disorders • Metabolic Disorders • Respiratory Diseases

Rare Cause of Refractory Hypotention during Cardiopulmonary Bypass (ASA 2025) - "Despite pre-medication, he developed severe vasoplegia after initiation of cardiopulmonary bypass (CPB) that was unresponsive to epinephrine. Hydroxocobalamin and methylene blue both resulted in transient hemodynamic stability. The diagnosis and management of patients with systemic mastocytosis undergoing cardiac surgery is challenging due to simultaneous presence of multiple triggering mechanisms (medications, ischemia-reperfusion, and the blood-artificial surface interface) and multiple causes of hypotension. Multidisciplinary planning, intraoperative communication, and a holistic assessment are key to ensuring a successful operation."

Cardiovascular • Hypotension • Reperfusion Injury

Hypotension Following Custodiol HTK Cardioplegia Administration: A Single Institution Retrospective Review (ASA 2025) - "Use of adjunctive vasopressors, such as methylene blue and hydroxocobalamin, and ensuring that patients are not hypotensive prior to cardioplegia administration may reduce the severity and duration of hypotension. Custodiol cardioplegia administration is associated with a high rate of hypotension in patients undergoing minimally invasive valve surgery, despite aggressive treatment with vasopressor medications. The hypotension is severe but brief, and rapidly improves after completion of cardioplegia administration. To the best of our knowledge, this is the first study describing the incidence, severity, and duration of hypotension with Custodial cardioplegia administration."

Retrospective data • Review • Hypotension

Assessment of Risk Factors for Vasoplegic Syndrome in Patients Undergoing Cardiac Surgery With Cardiopulmonary Bypass. (PubMed, Cureus) - "Hydralazine was the only pre-operative factor identified with a higher incidence of usage in the VS group. Further research is needed to determine the clinical significance of this association."

Journal • Cardiovascular • Critical care • Hypotension

Milder Form of Cobalamin C Disease May Be Missed by Newborn Screening: The Importance of Methylmalonic Acid Assessment. (PubMed, Int J Neonatal Screen) - "This approach allows for early diagnosis and immediate treatment with hydroxocobalamin in patients with mild CblC deficiency, resulting in early intervention, effective metabolic control, and, based on current follow-up, normal neurodevelopmental outcomes. Our findings highlight the essential role of second-tier MMA testing in improving the detection of mild CblC deficiency during NBS."

Journal