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

Two fatalities from sodium azide ingestion: delayed enhanced elimination was not effective. (PubMed, Clin Toxicol (Phila)) - "Enhanced elimination techniques were attempted, albeit not immediately, and the delay in initiating hemodialysis and plasma exchange may have limited any potential benefit. Enhanced elimination did not appear to alter the course of toxicity in these two patients who ingested at least 2 g of sodium azide."

Journal • Cardiovascular • Hypotension

Outcomes After Kidney Transplantation from Cyanide-Poisoned Donors (WTC 2025) - "This report examines successful kidney transplantations from two cyanide-poisoned donors treated with hydroxocobalamin.* In Korea, there have been two cases of cyanide-poisoned donors to date, and the outcomes of the recipients were analyzed.* The first case involved a 54-year-old male who ingested potassium cyanide... These cases demonstrate that successful kidney transplantation from cyanide-poisoned donors is possible even in the absence of cyanide blood testing, with appropriate antidote therapy, careful monitoring of renal function, and timing of surgery to account for the half-life of cyanide."

Transplantation

Low Back Pain Management with a Combination of Uridine Triphosphate, Cytidine Monophosphate, and Hydroxocobalamin: A Systematic Review and Meta-Analysis (PubMed, Rev Bras Ortop (Sao Paulo)) - "Peripheral neurotrophic substances, such as pyrimidine nucleotides (uridine triphosphate and cytidine monophosphate) combined with vitamin B12 (hydroxocobalamin), have been used as anabolic precursors able to provide spinal nerve roots with triggering elements useful for nerve and glial cells regeneration, once a likely spinal compression mechanism is contained. The authors performed a systematic review and meta-analysis with the above combination with the aim of better determining its role in low back pain management."

Journal • Retrospective data • Back Pain • Lumbar Back Pain • Musculoskeletal Pain • Pain

Lowback Pain Management with a Combination of Uridine Triphosphate, Cytidine Monophosphate, and Hydroxocobalamin: A Systematic Review and Meta-Analysis. (PubMed, Rev Bras Ortop (Sao Paulo)) - "Peripheral neurotrophic substances, such as pyrimidine nucleotides (uridine triphosphate and cytidine monophosphate) combined with vitamin B12 (hydroxocobalamin), have been used as anabolic precursors able to provide spinal nerve roots with triggering elements useful for nerve and glial cells regeneration, once a likely spinal compression mechanism is contained. The authors performed a systematic review and meta-analysis with the above combination with the aim of better determining its role in low back pain management."

Journal • Retrospective data • Back Pain • Lumbar Back Pain • Musculoskeletal Pain • Pain

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

Hydroxocobalamin Dosing Strategies for Vasoplegic Syndrome Post-cardiac Surgery: A Retrospective Cohort Study. (PubMed, Cureus) - "Bolus and extended infusion hydroxocobalamin dosing showed no significant difference in NEE reduction at 12 hours, though the bolus group had a higher NEE AUC, suggesting a less sustained effect. Further research is needed to optimize dosing strategies for vasoplegic syndrome post-cardiac surgery."

Journal • Retrospective data • Cardiovascular • Critical care • Hypotension

Hydroxocobalamin for vasoplegia in cardiac surgery: a retrospective cohort analysis. (PubMed, Br J Anaesth) - "Hydroxocobalamin administration was associated with reduced vasopressor requirement over 24 h, but not thereafter. Robust trials are needed to determine whether this relationship is causal, and whether a reduction in vasopressor use improves substantive clinical outcomes."

Journal • Retrospective data • Cardiovascular • Gastrointestinal Disorder • Infectious Disease • Renal Disease • NPHS1

Nitrous Oxide: No More a Laughing Matter. (PubMed, Cureus) - "A genetic predisposition may contribute to the development of this myelopathy, particularly due to polymorphisms in the gene responsible for vitamin B12 processing. Our case is distinct in its presentation, involving prolonged exposure over two years, thoracic dorsal column involvement, and rapid, significant recovery within two months."

Journal • Ataxia • CNS Disorders • Movement Disorders

The effect of parenteral vitamin B12 treatment on its plasma metabolomic profile and on functional biomarkers of its deficiency. (PubMed, Sci Rep) - "We assessed B12 deficiency through non-invasive [13C]-propionate oxidation breath test to derive functional cut-off and tested its sensitivity in response to acute change in B12 status in low B12 adult male participants by parenterally administering 3 mg hydroxocobalamin and profiling through untargeted and targeted B12 related metabolites...Parenteral B12 treatment increased [13C]-propionate oxidation (14.9%, range 1.1 to 66.9) significantly and was also associated with significant alterations (p < 0.05) in B12, HoloTc, MMA, Hcy concentrations, cB12, and associated functional metabolites like propionylcarnitine (C3), its ratio to acetylcarnitine (C3/C2) and palmitoylcarnitine (C3/C16). This study explores the clinical utility of propionate breath test to define functional B12 deficiency and associated metabolites through omics-based approach.This study was registered in Clinical Trials Registry of India (CTRI) with the registration number CTRI/2018/04/012957..."

Biomarker • Journal

FULMINANT CYANIDE TOXICITY FROM APRICOT KERNEL INGESTION: RAPID REVERSAL WITH HYDROXOCOBALAMIN THERAPY (CHEST 2025) - No abstract available

Modulation of conformational features and oligomerization of MMACHC by cobalamin variants: impact of the R161Q mutation in cblC disease. (PubMed, Eur Biophys J) - "The cobalt ion can be bound to a variety of upper axial ligands, which vary among different cobalamin forms, including hydroxocobalamin (OHCbl), cyanocobalamin (CNCbl), methylcobalamin (MeCbl), and adenosylcobalamin (AdoCbl). In addition, we also assessed how the R161Q mutation in MMACHC alters the affinity of this protein for the different vitamin B12 forms, leading to decreased stability and impaired homodimerization, a process likely relevant to its functional role. Our findings provide molecular insights into cblC pathogenesis and advance our understanding of MMACHC structure-function relationships."

Journal • CBLC

Cytokines in saliva, serum, and temporomandibular joint synovial fluid in children with juvenile idiopathic arthritis: An explorative cross-sectional study. (PubMed, Pediatr Rheumatol Online J) - "In this exploratory study, several proinflammatory cytokines were found in higher concentrations in saliva in JIA-TMJ compared to saliva from the controls. No differences were seen in serum between the groups. Some pro- and anti-inflammatory cytokines detected in JIA-TMJ synovial fluid were found in higher concentrations compared to TMJ synovial fluid from healthy adult reference data."

Journal • Observational data • Idiopathic Arthritis • Immunology • Rheumatology • CCL11 • CSF2 • FGF • IL10 • IL12A • IL13 • IL17A • IL1B • IL4 • IL5 • IL9

Biologic rationale and evidence for high-dose hydroxocobalamin in septic shock. (PubMed, Curr Opin Crit Care) - "High-dose HOC is a promising, nontoxic intervention that targets the pathophysiologic pathway of septic shock. Despite compelling observational and Phase IIa trial data, a pivotal phase III trial testing high-dose HOC in adults with septic shock is required before widespread use can be recommended."

Journal • Infectious Disease • Inflammation • Septic Shock

One Team: Identifying Prehospital Provider Needs for Burn Patient Outreach and Education. (PubMed, J Burn Care Res) - "Approved pain medications included morphine, ketamine, and fentanyl; two agencies mentioned hydroxocobalamin in their protocol. Minimal information on burns is included in regular continuing education. Practices differ between emergency medical service agencies, even though the quality of prehospital care has a sizeable impact on outcomes."

Journal • Pain • Thermal Injury

Intramuscular Vitamin B12 Treatment in Transcobalamin II Deficiency: Case Series Clinical Outcomes. (PubMed, Appl Clin Genet) - "The majority of patients were treated with intramuscular hydroxocobalamin (OH-Cbl), resulting in clinical and biochemical improvements...Regular monitoring of clinical and neurological status, as well as MMA and tHcy levels, is essential to ensure adequate therapy. Intramuscular treatment is the preferred route to prevent neurological deficits and optimal markers normalization."

Clinical data • Journal • Hematological Disorders

Prognostic value of the vasoactive-inotropic score in predicting outcomes following LVAD implantation. (PubMed, JHLT Open) - "VIS was calculated at 0, 6, 12, and 24 hours postoperatively, and the maximum VIS(VISmax) within the first 24 hours was determined: VIS = dopamine (mcg/kg/min) + dobutamine (mcg/kg/min) + 100*epinephrine (mcg/kg/min) + 10*milrinone (mcg/kg/min) + 10,000*vasopressin (units/kg/min) + 100*norepinephrine (mcg/kg/min). Strategies such as preoperative hydroxocobalamin administration may mitigate postoperative vasoplegia. Further studies are warranted to refine risk stratification and optimize management for these high-risk patients."

Biomarker • Journal • Cardiovascular

Resuscitating Through the Smoke: Novel Use of Cyanocobalamin in a Pediatric House Fire Victim. (PubMed, Cureus) - "The intervention was well tolerated and associated with a significant 13.8% decrease in carboxyhemoglobin levels within 20 minutes, alongside progressive improvement in metabolic parameters. Although the patient ultimately suffered irreversible hypoxic-ischemic brain injury, this case highlights the potential utility of push-dose hydroxocobalamin in time-critical resuscitation scenarios involving suspected cyanide toxicity."

Journal • CNS Disorders • Pediatrics • Vascular Neurology

Hydroxocobalamin in Septic Shock Management - Should It Be Introduced Sooner? (ATS 2025) - "His hemodynamics continued to deteriorate, requiring initiation of norepinephrine, vasopressin, and stress-dose hydrocortisone. Despite this, his mean arterial pressure continued to drop, and epinephrine and phenylephrine were added, with little benefits...Hydroxocobalamin is often only used when patients fail to respond to vasopressors, though a randomized controlled trial showed administration reduced the dose of vasopressor administered2. More multicentered, randomized controlled trials and further guidelines are needed to determine when hydroxocobalamin should be used during septic shock management to maximize clinical utility and outcomes."

Acute Myelogenous Leukemia • Hematological Disorders • Hematological Malignancies • Leukemia • Oncology • Septic Shock

Salts and Vitamins: Resolution of Refractory Septic Shock With Methylene Blue and Hydroxocobalamin (ATS 2025) - "Despite prompt initiation of empiric antibiotics and aggressive fluid resuscitation, the patient deteriorated requiring the sequential initiation of norepinephrine, vasopressin, phenylephrine, epinephrine, and stress-dose steroids...His clinical course was complicated by anuric renal failure and profound metabolic acidosis presumably from home diuretic and metformin use...Our patient demonstrated an immediate and sustained hemodynamic response following a single dose of methylene blue and high-dose hydroxocobalamin while on maximum vasopressor support and stress-dose steroids. It highlights that further investigation is warranted to assess the effect of combination methylene blue with hydroxocobalamin therapy on improving patient outcomes in septic shock."

Cardiovascular • Chronic Kidney Disease • Congestive Heart Failure • Diabetes • Gastroenterology • Heart Failure • Hepatology • Hypertension • Metabolic Disorders • Nephrology • Pain • Renal Disease • Septic Shock

Shock- No Cap (ATS 2025) - "Despite aggressive pressor support, fluids, albumin, hydroxocobalamin, methylene blue and steroids, he remained hypotensive. Many cases involve the presence of paraproteinemia and preceding flu-like illness which plays an unknown role in the disease. There is no definitive treatment for it although case reports have shown improvement with IVIG and terbutaline/aminophylline after fluid resuscitation during the acute phase."

Cardiovascular • CNS Disorders • Hematological Disorders • Hypertension • Infectious Disease • Influenza • Metabolic Disorders • Monoclonal Gammopathy • Novel Coronavirus Disease • Pain • Renal Disease • Respiratory Diseases

A Rare Case of Hydrogen Sulfide Toxicity From a Malfunctioning Car Battery (ATS 2025) - "The hospital course was complicated by myopericarditis and heart failure with reduced ejection fraction (EF 15%) managed with aspirin and colchicine per cardiology recommendations...In severe cases, treatment may include sodium nitrite, hydroxocobalamin, or methylene blue... H2S is a known occupational exposure that is highly toxic; it is rarely seen in other scenarios such as exposure to malfunctioning car batteries. For patients that are found altered in vehicles that smell of sulfur, clinicians should have high suspicion for H2S toxicity and collaborate with medical toxicology."

Clinical • Cardiovascular • CNS Disorders • Congestive Heart Failure • Conjunctivitis • Heart Failure • Ocular Infections • Ocular Inflammation • Ophthalmology • Pain • Respiratory Diseases

Complete Immunophenotypic Reversal of Chronic Lymphocytic Leukaemia With High Dose Parenteral Methylcobalamin: A Case Report and Brief Review of Cobalamin in Cancer. (PubMed, Cancer Rep (Hoboken)) - "This change in cobalamin form and dose proved a critical turning point. Complete disappearance of the lymphocytosis also coincided with a severe infection and an even further temporary increase of the parenteral methylcobalamin dose, both catalytic factors. In the 4th and 5th years following this, the patient's repeated immunophenotyping showed no clonal disease present. A brief review of the field of cobalamin in cancer research and treatment is given, with discussion of the various mechanisms by which cobalamins may impact on cancer/CLL. Historic analysis reveals that cyanocobalamin is generally cancer promotional, whereas hydroxocobalamin, methylcobalamin and adenosylcobalamin are cancer protective and cytotoxic. It is hypothesised that the actions of cobalamin in cancer aetiology and oncogenesis/progression are intertwined with those of nitric oxide, which tumours regulate to dupe the immune system to their presence, by causing a functional cobalamin deficiency..."

Journal • Review • Chronic Lymphocytic Leukemia • Hematological Malignancies • Infectious Disease • Leukemia • Oncology

Clinical diagnosis, treatment, and genetic analysis of adolescent onset holocarboxylase synthetase deficiency and cobalamin C deficiency: A case report and literature review. (PubMed, Metabol Open) - "Treatment with hydroxocobalamin, betaine, and biotin is effective. Two novel mutations in the HLCS gene causative for HCSD have been reported, providing a broader foundation for mutational screening and offering insights into the diagnosis and treatment of similar disorders."

Journal • CNS Disorders • Epilepsy • Genetic Disorders • Mental Retardation • Metabolic Disorders

Impact of Drugs Used in Intensive Care on Routine Coagulation Testing. (PubMed, Diagnostics (Basel)) - "In this review, we have conducted a critical analysis of the literature to define: (1) the impact of hydroxocobalamin, intravenous lipid emulsion, and propofol on chromogenic assays; (2) the impact of PEGylated compounds, emicizumab, recombinant activated factor VII, antibiotics, and sugammadex on chronometric assays; (3) the challenges associated with bridging anticoagulation in the ICU as well as the effect of N-acetylcystein, serotonin reuptake inhibitors, and tramadol on the hemostasis system. For each drug, we specify the routine coagulation assay that is impacted, whether this is linked to an in vitro interference or an in vivo effect, and the potential consequences on patient management."

Journal • Review • Critical care