The Use of High-Dose Hydroxocobalamin for Vasoplegic Syndrome

High-dose hydroxocobalamin for vasoplegic syndrome causing false blood leak alarm

“…High-dose hydroxocobalamin [5 g; a much higher dose than the 100–200 µg intramuscular (IM) dose used in the treatment of vitamin B12 deficiency and 1000 µg IM for Schilling test] is believed to be safe with few adverse effects [6–8]. High-dose hydroxocobalamin is becoming increasingly utilized in the treatment of post–cardiopulmonary bypass vasoplegic syndrome [9, 10], as in our case presentation. Thus it is important for clinicians to have a greater appreciation and understanding of hydroxocobalamin, the limitations on renal replacement options, and how these difficulties can be overcome with available resources in a safe and timely manner.…”

“…The prevailing mechanism for this effect is the sequestration and subsequent depletion of nitric oxide in vascular endothelium [9–14], an important factor in the underlying mechanism of vasoplegic syndrome [5, 15, 16]. Hence hydroxocobalamin has been utilized to treat refractory vasoplegic syndrome in the setting of cardiac surgery following cardiopulmonary bypass [10, 11]. …”

A modern literature review of carbon monoxide poisoning theories, therapies, and potential targets for therapy advancement.

“…This compound is the main constituent of the Cyanokit TM , an FDA approved medication for the treatment of cyanide poisoning. Hydroxocobalamin has been shown to increase mean arterial pressures by binding NO, forming a vaso-innactive compound called nitrosocobalamin (Rajanayagam et al, 1993;Roderique et al, 2014). Hydroxocobalamin's low side effect profile and NO sequestering ability make it an ideal treatment for CO induced hypotension.…”

Hydroxocobalamin administration for treatment of vasoplegic syndrome associated with cardiopulmonary bypass causes red plasma

“…In pediatric patients, a dose of 70 mg/kg has been used outside the United States . An observed side effect of hydroxocobalamin is hypertension, which recently has led to its use for treatment of vasoplegic syndrome . Vasoplegic syndrome is a common complication in patients undergoing CPB and is characterized by significant hypotension, normal/high cardiac output, and low systemic vascular resistance .…”