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Hydroxycobalamin and Vasoplegia - #PHARMFAX

Updated: Jul 29, 2023

High-dose hydroxycobalamin (vitamin B12) has an FDA indication for cyanide toxicity, but has seen increased use for refractory vasoplegia rescue therapy.
 


High-dose hydroxycobalamin (vitamin B12) has an FDA indication for cyanide toxicity, but has seen increased use for refractory vasoplegia rescue therapy. Vasoplegia is characterized by hypotension in the setting of high pressor requirements and normal cardiac index It appears that nitric oxide and natrial natriuretic peptide increases cGMP, contributing to extensive vasodilation. The proposed mechanism of hydroxycobalamin are inhibition of NO synthase and enhancing elongation of hydrogen sulfide, a vasodilator. Once vasoplegia has been determined, methylene blue or hydroxycobalamin can be consdired. G6PD deficiency and serotonin syndrome limit use of the former. Hydroxycobalamin is given 5 grams IV over 15 minutes up to 2 doses. Considered as rescue therapy, evidence is limited to small trials and case reports. Adverse reactions include discolored urine, substantial increase in blood pressure, headache, and rash. It may also cause laboratory disturbances. Always consider patient and family wishes, prognosis, and futility with continued resuscitation. Hit the like and follow button for more. Share the #PHARMFAX with a friend, and I hope you learned something new. Recommended Read/Watch Push Dose Pressors: https://www.instagram.com/reel/CrbLHd4gvq6/ Shock States: https://www.instagram.com/reel/Cpxg0x5BW-4/ Vasopressor Basics: https://www.instagram.com/reel/CqG9_IADg6A/ The ALL PHARMWYZE SOURCE (including references) | www.pharmwyze.com #vasoplegia #cyanokit #wyzeselection #hydroxycobalamin #foamed #pharmacist #pharmwyze #pharmfax #criticalcare #emergencymedicine #studentpharmacist #nursingstudent #medicalstudent #pharmacy #medicine #nursing #meded

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