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

Complete Recovery Following Intentional Potassium Cyanide Poisoning Despite Delayed Hydroxocobalamin Administration: A Case Report. (PubMed, Cureus) - "Despite ingestion of a potentially lethal dose of cyanide and limited immediate availability of the antidote, complete clinical stabilization was achieved, and the patient was discharged in good general condition on hospital day 15 without permanent organ damage or neurological deficits. This case highlights the importance of early initiation of intensive supportive care to maintain vital functions and serve as a bridge until specific antidotal treatment can be administered."

Journal • Critical care • Metabolic Disorders • Respiratory Diseases

Methylene Blue or Hydroxocobalamin for Refractory Septic Shock? (CHEST 2026) - No abstract available

Septic Shock

Physicochemical and safety evaluation of an antioxidant ophthalmic hydrogel for corneal injuries. (PubMed, Int J Pharm) - "This work describes the development of antioxidant ophthalmic hydrogels containing Idebenone (IDB) and hydroxocobalamin (HCB) as a complement treatment for corneal injuries, using hydroxypropyl- β-cyclodextrin (HPβCD) to improve IDB aqueous solubility. Additionally, C. Elegans survival assay confirmed the treatment́s safety. Overall, the developed hydrogel, composed of P407 and HPβCD, shows potential as a safe topical platform to increase ocular residence time and provide localized antioxidant support during corneal injuries management."

Journal • Corneal Abrasion • Infectious Disease • Inflammation • Ocular Inflammation • Ophthalmology • Pain

Case Report: Persistent isolated hyperhomocysteinemia in an adolescent with celiac disease and homozygous MTHFR c.665C>T polymorphism: a multifactorial disturbance of one-carbon metabolism. (PubMed, Front Genet) - "Sequential trials of pyridoxine, hydroxocobalamin, and high-dose betaine produced modest or transient improvement...Combined oral methylfolate (1,000 µg daily) and vitamin B12 (cyanocobalamin 1,000 µg daily) reduced homocysteine from 66 to 24.6 μmol/L in 8 weeks. This case illustrates multifactorial hyperhomocysteinemia arising from interactions between celiac disease-related micronutrient vulnerability and reduced MTHFR activity. Recognition of gene-nutrient interactions is important when classical metabolic disorders are excluded and may guide targeted therapy."

Journal • Cardiovascular • Celiac Disease • Diabetes • Immunology • Metabolic Disorders • Otorhinolaryngology • Type 1 Diabetes Mellitus • MTHFR

Sodasulphanecobalamin provides rapid cyanide detoxification and hemodynamic rescue in a rat model of acute cyanide poisoning. (PubMed, Toxicol Appl Pharmacol) - "SSC was synthesized from hydroxocobalamin and sulfur-based precursors, characterized by HPLC, HR-MS, NMR, IR, and elemental analysis, with the coordination geometry pending X-ray crystallography...SSC is a fast-acting, well-tolerated cyanide antidote outperforming current therapies. Further studies are needed for dosing optimization and intramuscular administration."

Journal • Preclinical • Hematological Disorders

Vasoplegia in Cardiac Surgery and Mechanical Circulatory Support: From Cardiopulmonary Bypass to Advanced Circulatory Support Devices. (PubMed, J Cardiovasc Dev Dis) - "Key mechanistic pathways and current therapeutic strategies, including catecholamines, vasopressin, angiotensin II, methylene blue and hydroxocobalamin, are discussed. By integrating evidence from cardiac surgery, critical care and mechanical circulatory support, vasoplegia is presented as a unifying syndrome of extracorporeal circulation. This perspective may support earlier recognition, phenotype-based management and the development of more targeted therapeutic strategies in a clinically significant yet underexplored area of cardiovascular critical care."

Journal • Review • Cardiovascular • Critical care • Hematological Disorders • Inflammation • Reperfusion Injury • Transplantation

Cobalamin-Related Remethylation Disorders: Pregnancy Outcomes and Prenatal Treatment-New Cases and a Literature Study. (PubMed, J Inherit Metab Dis) - "All affected mothers were treated with hydroxocobalamin (OHCbl) during pregnancy and two also received betaine and carnitine...Collectively, our main findings support the safety of maternal and fetal OHCbl treatment during pregnancy. We recommend that when combined with preconception counselling, early standardized diagnosis, optimal monitoring and postnatal care, prenatal OHCbl therapy can improve pregnancy outcomes and mitigate neurodevelopmental and ophthalmic complications in cbl-RD."

Journal • Review • CNS Disorders • Epilepsy • Macular Degeneration • Nephrology • Ophthalmology • Renal Disease • Retinal Disorders

Refractory Vasoplegia in Outpatient Microdirect Laryngoscopy: Response to Hydroxocobalamin (ASA 2026) - "We present a case of refractory vasoplegia during outpatient microdirect laryngoscopy in a patient who had taken both tamsulosin and olmesartan-hydrochlorothiazide on the day of surgery. Despite high-dose vasopressors, hypotension persisted but improved following hydroxocobalamin administration. This case highlights a potential role for hydroxocobalamin in managing vasoplegia in non-cardiac, ambulatory surgical settings."

Clinical • Hypotension

The Utility of Hydroxocobalamin for Catecholamine-Resistant Vasoplegia in Liver Transplantation (ASA 2026) - "The patient had a profound response to hydroxocobalamin facilitating immediate reduction of high dose norepinephrine and vasopressin which were ultimately discontinued within 15 minutes of cyanokit administration. This case discusses the utility of hydroxocobalamin for management of catecholamine-resistant vasoplegia in patients undergoing liver transplantation."

Fibrosis • Hepatitis C • Hepatology • Immunology • Infectious Disease • Inflammation • Transplantation

Respiratory Failure After Total Artificial Heart Implantation (ASA 2026) - "Intraoperative management was notable for profound vasoplegia responsive to hydroxocobalamin, preload sensitive low TAH fill volumes requiring TEE guided volume assessment, and acute pulmonary edema with hypoxemia. This case highlights anesthetic decision making for TAH implantation, device specific hemodynamic troubleshooting, and respiratory failure management after mechanical circulatory transition."

Cardiovascular • Heart Failure • Respiratory Diseases

VA-ECMO for Refractory Ventricular Arrhythmia and Severe Right Ventricular Dysfunction Following CABG (ASA 2026) - "The intraoperative course was notable for refractory vasoplegia and low cardiac output syndrome post-pump, managed with vasopressors, corticosteroids, hydroxocobalamin, and high-dose inotropic support...However, she continued to have refractory VT requiring emergent VA-ECMO. This case highlights the challenges and considerations of ECMO candidacy, cannulation strategy, configuration selection, and the role of LV decompression during peripheral VA-ECMO."

Cardiovascular • Coronary Artery Disease • Heart Failure • Ventricular Tachycardia

Suspected Cefazolin-Induced Anaphylaxis & Refractory Vasoplegia Treated with Methylene Blue and Hydroxocobalamin after Coronary Artery Bypass Surgery (ASA 2026) - "The course was further complicated by severe thrombocytopenia (3x103uL), likely drug induced. This case highlights early recognition of rare antibiotic-associated reactions and successful use of combined vasoplegia therapies."

Surgery • Hematological Disorders • Thrombocytopenia

Liver Transplant Post-Reperfusion Syndrome Vasoplegia- A Case Report (ASA 2026) - "Treatments include catecholamines, vasopressin, ascorbic acid, thiamine, corticosteroids, methylene blue, hydroxocobalamin, and angiotensin II.We present a 48-year-old female with alcohol-associated cirrhosis and hepatopulmonary syndrome who underwent liver transplantation complicated by severe post-reperfusion vasoplegia requiring hydroxocobalamin, methylene blue, and massive transfusion (13U pRBCs, 6U FFP, 5U cryoprecipitate, 5U platelets). Despite intervention, she developed primary non-function requiring re-listing for transplant."

Case report • Clinical • Fibrosis • Hepatology • Hypotension • Immunology • Respiratory Diseases • Transplantation

Use of Hydroxocobalamin in Extracorporeal Cardiopulmonary Resuscitation associated vasoplegia (ASA 2026) - "A single 5 g IV dose of hydroxocobalamin resulted in rapid hemodynamic improvement, permitting discontinuation of norepinephrine and vasopressin within 15 minutes and reduction of epinephrine. ECMO was discontinued on day 3, and the patient was discharged on day 18. This case highlights hydroxocobalamin as an effective therapy for vasoplegic shock during extracorporeal cardiopulmonary resuscitation (ECPR)."

Cardiovascular • Heart Failure

Vasoplegic Shock in Orthotopic Liver Transplantation: A Case of Hemodynamic Instability (ASA 2026) - "Administration of iv hydroxocobalamin (5 g), temporarily decreased vasopressor requirements but its effect was short lived. We discuss risk factors and pathophysiology of vasoplegic shock, examine the role of transfusion in exacerbating vasoplegia and review treatment strategies in refractory states."

Clinical • Cardiovascular • CNS Disorders • Fibrosis • Hematological Disorders • Hepatic Encephalopathy • Hepatology • Immunology • Metabolic Dysfunction-Associated Steatohepatitis • Portal Hypertension • Transplantation

Refractory Vasoplegic Shock After Orthotopic Heart Transplant in a Bridge-to-Transplant Patient: Early VA-ECMO, Hydroxocobalamin, and CRRT as Multimodal Rescue (ASA 2026) - "Over subsequent days, systemic vascular tone improved, end-organ function recovered, and ECMO was successfully decannulated. The patient was extubated with preserved neurologic function and stable graft performance."

Clinical • Cardiovascular • Congestive Heart Failure • Heart Failure • Metabolic Disorders • Transplantation

Hydroxocobalamin for Catecholamine-Refractory Vasoplegic Shock After ERCP (ASA 2026) - "Within one hour, the patient required maximum dosages of four vasopressors, including 0.4mcg/kg/hr of epinephrine. Within three hours all vasopressors were discontinued and the patient was extubated later that day. This case illustrates the potential role for high-dose hydroxocobalamin adjunctive therapy in catecholamine-resistant vasoplegic shock."

Cardiovascular • Hepatology • Hypotension • Pulmonary Embolism • Respiratory Diseases

Methylene Blue Versus Hydroxocobalamin for Postprocedural Shock Following Cardiac Surgery (ASA 2026) - "Abstract is embargoed at this time."

Surgery • Cardiovascular

PBLD214. Rescue Therapy Dilemmas in Post-CPB Vasoplegia (1 CME) (ASA 2026) - "In addition adjunctive therapy (ascorbic acid 6g, hydrocortisone 200mg/day, thiamine 400mg/day) have been described in the literature but with unclear benefit. Hydroxocobalamin (5g IV) functions as a nitric oxide scavenger and antioxidant, providing vasopressor-sparing effects in the first 24 hours post-CPB. Angiotensin II acts through AT1 receptor stimulation for direct vasoconstriction, demonstrating catecholamine-sparing properties and successful resolution of refractory vasoplegia when conventional therapy fails."

Cardiovascular • Cognitive Disorders • Congestive Heart Failure • Diabetes • Heart Failure • Hypotension • Metabolic Disorders • Renal Disease

PBLD142. Rescue Therapy Dilemmas in Post-CPB Vasoplegia (1 CME) (ASA 2026) - "In addition adjunctive therapy (ascorbic acid 6g, hydrocortisone 200mg/day, thiamine 400mg/day) have been described in the literature but with unclear benefit. Hydroxocobalamin (5g IV) functions as a nitric oxide scavenger and antioxidant, providing vasopressor-sparing effects in the first 24 hours post-CPB. Angiotensin II acts through AT1 receptor stimulation for direct vasoconstriction, demonstrating catecholamine-sparing properties and successful resolution of refractory vasoplegia when conventional therapy fails."

Cardiovascular • Cognitive Disorders • Congestive Heart Failure • Diabetes • Heart Failure • Hypotension • Metabolic Disorders • Renal Disease

PN106. All About Vasopressors: Optimizing Support and Minimizing Harm in Vasoplegic Patients (1 CME) (ASA 2026) - "Key points include use of novel vasopressors (angiotensin II, IV methylene blue, hydroxocobalamin), and vasopressor use in patients with cardiac disease (valvular heart disease, obstructive hypertrophy, and pulmonary hypertension), septic shock, and treatment-refractory vasoplegia...Summarize hemodynamic effects, including possible adverse effects, of vasopressors in patients with cardiac disease.SessionLearningObjective3: Organize a differential diagnosis for hypotension in patients who to fail to respond to vasopressor use. Devise a strategy for managing treatment-refractory vasoplegia."

Clinical • Cardiovascular • Heart Failure • Hypotension • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases • Septic Shock

Myelodysplasia uncovering transcobalamin deficiency. (PubMed, BMJ Case Rep) - "Whole exome sequencing revealed a homozygous pathogenic variant, c.927_930del (p.(Cys309Trpfs*50)), in the TCN2, consistent with a diagnosis of autosomal recessive transcobalamin deficiency. Treatment with parenteral hydroxocobalamin resulted in dramatic improvement in her symptoms and resolved the myelodysplastic changes."

Journal • Ataxia • Cytomegalovirus Infection • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Hematological Malignancies • Immunology • Infectious Disease • Movement Disorders • Myelodysplastic Syndrome • Oncology • Pain

Hereditary spherocytosis mimicking cobalamin metabolic disorder at newborn screening (SSIEM 2026) - "Supplementation with cyanocobalamin did not normalize the markers, while hydroxocobalamin caused only a temporary improvement... Since the biochemical profile suggesting a cobalamin disorder remained unexplained, hematological evaluation was performed, revealing mild anemia, reticulocytosis, hyperbilirubinemia, and increased red cell distribution width. Peripheral blood smear showed anisopoikilocytosis with micro-spherocytes, and osmotic fragility testing led to a diagnosis of hereditary spherocytosis (HS). Chronic hemolysis in hereditary spherocytosis is associated with increased erythropoietic turnover, which may raise the demand for vitamins involved in DNA synthesis."

Genetic Disorders • Hematological Disorders • Hepatology • Metabolic Disorders

Vitamin-B12 status in a cohort of mother-infant dyad: an Italian single center experience (SSIEM 2026) - "At T0 a 1 mg oral dose of Hydroxocobalamin supplementation followed by 2mg/weekly for infants, until the complementary feeding was routinely prescribed... Our analysis showed that infant B12 status depends on maternal status during pregnancy, and that low B12 levels may be linked to cultural-dietary changes. Measuring b12 status (MMA, Hcy) during pregnancy represents a useful tool to guide tailored B12 supplementation, particularly in settings where vegetarian dietary practices are common."

Clinical • Metabolic Disorders

Missed Opportunities in Treatable Transcobalamin II Deficiency Diagnosed After Two Previously Affected Sibling Deaths (SSIEM 2026) - "Following confirmation of the diagnosis, targeted treatment with Parenteral hydroxocobalamin therapy was initiated... This case study underscores the critical role of early genetic testing in infants presenting with suggestive metabolic features, particularly in families with prior unexplained sibling deaths. Timely diagnosis of treatable inherited metabolic disorders such as Transcobalamin II deficiency can significantly alter clinical outcomes and enable appropriate management, genetic counseling, and informed reproductive planning in future pregnancies. This report emphasizes the importance of increasing awareness among clinicians regarding early referral for genetic evaluation in recurrent, unexplained pediatric illness or mortality."

Developmental Disorders • Infectious Disease • Metabolic Disorders