Treatment of Vasoplegic Syndrome With Intravenous Hydroxocobalamin During Liver Transplantation

Hydroxocobalamin for the treatment of cardiac surgery-associated vasoplegia: a case series

“…Case studies of three liver transplant patients reported repeated doses of 125-250 mg supplemented by 250-500 mgÁhr -1 infusions. 14,16 Higher than recommended dosages of MB have been associated with splanchnic vasospasm; it is unknown if this is a potential problem with B 12 administration. Abrupt and prolonged increases in MAP induced by norepinephrine and NO inhibitors in patients with septic shock have been associated with increased mortality 24 ; over the longer term, blood pressure overshoot resulting from excessive vasoconstriction may result in ischemic injury and increased incidence of acute kidney injury and multiple organ failure.…”

“…12-16 B 12 is an NO scavenger commonly used in the treatment of acute cyanide poisoning; administration is associated with clinically significant increases in blood pressure. [12][13][14][15][16] The aim of this present report was to describe the results from a retrospective chart review of patients from a single institution undergoing cardiac surgery with CPB, where B 12 was used to reverse perioperative or post-CPB hypotension. We describe patterns of B 12 use, patient hemodynamic responses, and clinical characteristics in this case series.…”

Vasoplegic syndrome following cardiothoracic surgery—review of pathophysiology and update of treatment options

“…Recently, case reports and series have demonstrated an increase in MAP in patients with vasoplegic syndrome when hydroxocobalamin is administered at a dose of 5 g over 15 min [81][82][83][84][85]. The largest cohort of patients published found a variety of responses when used in refractory cases [76].…”

High‐Dose Vitamin B12 in Vasodilatory Shock: A Narrative Review

“…Even though H 2 S levels have been shown to be elevated in observational human septic shock studies, there are no reports of using IV hydroxocobalamin in human septic shock. Human data for IV hydroxocobalamin are limited to single case reports and case series in patients with post‐CPB vasodilatory shock (Table ) …”

“…Within minutes, 1 vasopressor was discontinued, and the dose was reduced in a second. Since, 6 case reports (each ≤2 patients) totaling 8 patients have shown sustained improvement in hemodynamics after IV hydroxocobalamin in post‐CPB vasoplegia (Table ) . Four patients had post‐CPB vasoplegia after liver transplant and 4 had post‐CPB vasoplegia after a cardiac procedure …”