Hydroxocobalamin: What is it? Vitamin B12 Benefits, Uses, Dosage and Deficiency

It is a chemical compound with a structure similar to vitamin B12.

Cobalamin is another name for vitamin B12, an essential nutrient necessary for proper metabolism and energy production.

Although the human body does not produce hydroxocobalamin, bacteria in the digestive tract can convert it to a usable form.

Commercial and pharmaceutical versions of hydroxocobalamin also use bacteria to create large volumes of the compound for therapeutic purposes.

Hydroxocobalamin, partially identifiable by its red color, plays an integral role in DNA synthesis and supports cell replication .

The compound also plays an important role in converting harmful homocysteine ​​to beneficial methionine, an essential amino acid.

It helps with energy production and is necessary for normal brain function and nervous system function.

A remedy for B12 deficiency

Hydroxocobalamin is commonly used to treat vitamin B12 deficiency. When the body’s stores of vitamin B12 are low, hydroxocobalamin injections are often used to restore B12 levels.

Vitamin B12 deficiency is linked to many negative health effects, including neurological, gastroenterological, psychiatric, and blood disorders.

There is no doubt that it is one of the most important nutrients that our body needs. In one case, an individual suffering from seizures and psychotic symptoms made a full recovery after the B12 intervention.

Causes of vitamin B12 deficiency

Whether you’re avoiding animal products or suffering from digestive or absorption issues, you can develop a B12 deficiency.

Even meat eaters who consistently consume this essential nutrient can become deficient in certain circumstances.

The most common causes of a vitamin B12 deficiency include:

Pernicious anemia

Pernicious anemia occurs when the body does not absorb B12 and, in turn, does not make enough red blood cells. People with this condition should regularly receive B12 supplements.

Hydrococobalamin injection has traditionally been used against pernicious anemia based on research that it is more easily preserved by the body.

New research has suggested oral ingestion of hydroxocobalamin (or cyanocobalamin) as an alternative option for vitamin B12 supplementation.

Strict Vegetarianism / Veganism

People who follow a strict vegetarian or vegan diet may not get enough vitamin B12. The vitamin is present mainly in foods of animal origin such as meat, eggs, fish and milk.

This puts many health-conscious vegetarians and vegans at risk, making supplementation the primary route through which the nutrient can and should be obtained.

Pregnant women who are vegetarian or vegan will also need to supplement, as a deficiency can have a huge impact on the fetus.

Digestive malabsorption

If the stomach or small intestine experience functional or structural damage, the body may have trouble absorbing enough vitamin B12 (and other nutrients).

People with celiac disease also have a hard time digesting gluten and absorbing nutrients.

Some medical conditions can also prevent the stomach or small intestine from properly secreting intrinsic factor, the intestinal protein necessary for the absorption of B12.

Harmful organisms

Unfriendly organisms in the intestines can reduce the amount of B12 available for absorption. For example, tapeworms can consume large amounts of vitamin B12, leading to a deficiency in this powerful nutrient.

A condition like this can lead to gastric atrophy, a chronic irritation of the stomach lining. This can cause the loss of gastric cells that produce essential digestive substances necessary for the correct use of B12.

Hydroxocobalamin benefits and uses

In addition to remedying B12 deficiency, hydroxocobalamin can provide additional benefits for the brain and body.

Cyanide poisoning remedy

In 2006, hydroxocobalamin received approval for use as a treatment for cyanide poisoning. Hydroxocobalamin binds to cyanide molecules to form cyanocobalamin, a vitamin B12.

As an antidote to cyanide, hydroxocobalamin has been considered safe and highly effective.

Hydroxocobalamin is indicated for the treatment of known or suspected cyanide poisoning.

Identifying patients with cyanide poisoning

Cyanide poisoning can be the result of inhalation, ingestion, or dermal exposure to various cyanide-containing compounds, including smoke from indoor fires.

Sources of cyanide poisoning include hydrogen cyanide and its salts, cyanogenic plants, aliphatic nitriles, and prolonged exposure to sodium nitroprusside.

The presence and extent of cyanide poisoning is often initially unknown. There is no widely available, rapid, confirmatory cyanide blood test.

Treatment decisions should be made based on the medical history and signs and symptoms of cyanide poisoning.

If the clinical suspicion of cyanide poisoning is high, Hydroxocobalamin should be administered without delay.

Common Signs and Symptoms of Cyanide Poisoning
  • Headache.
  • Confusion.
  • Dyspnoea.
  • Chest tightness.
  • Nausea.
  • Altered mental state (eg, confusion, disorientation).
  • Seizures or coma
  • Mydriasis
  • Tachypnea / hyperpnea.
  • Bradypnea / apnea.
  • Hypertension / Hypotension.
  • Cardiovascular collapse
  • Vomiting
  • Plasma lactate concentration ≥8 mmol / L.

In some settings, panic symptoms, such as tachypnea and vomiting, can simulate the first signs of cyanide poisoning.

The presence of an altered mental state (eg, confusion and disorientation) and / or mydriasis suggests true cyanide poisoning, although these signs can also occur with other toxic exposures.

Smoke inhalation

Not all smoke inhalation victims will have cyanide poisoning and may experience burns, trauma, and exposure to other toxic substances, making the diagnosis of cyanide poisoning particularly difficult.

Before administration of Hydroxocobalamin, smoke inhalation victims should be evaluated for the following:

  • Exposure to fire or smoke in an enclosed area.
  • Soot around the mouth, nose, or oropharynx.
  • Altered mental state

Although hypotension is highly suggestive of cyanide poisoning, it is present in only a small percentage of cyanide poisoned smoke inhalation victims.

A plasma lactate concentration ≥10 mmol / L is also indicative of cyanide poisoning.

This is a higher value than the one normally listed on the Isolated Cyanide Poisoning Signs and Symptoms chart because the carbon monoxide associated with smoke inhalation also contributes to lactic acidemia.

If cyanide poisoning is suspected, treatment should not be delayed to obtain a plasma lactate concentration.

Use with other cyanide antidotes

Caution should be exercised when other cyanide antidotes are administered simultaneously with Hydroxocobalamin as the safety of co-administration has not been established.

If the decision is made to administer another cyanide antidote with Hydroxocobalamin, these drugs should not be administered simultaneously in the same IV.

Dosage and administration of Hydroxocobalamin

Comprehensive treatment of acute cyanide poisoning requires support of vital functions.

Recommended dosage

The starting dose of hydroxocobalamin for adults is 5 g given as an intravenous infusion over 15 minutes (approximately 15 ml / min). Administration of the entire vial constitutes a complete starting dose.

Depending on the severity of the poisoning and the clinical response, a second dose of 5 g can be administered by intravenous infusion to obtain a total dose of 10 g.

The infusion rate for the second dose can range from 15 minutes (for in extremis patients) to two hours, as clinically indicated.

Preparation of solution for infusion

The 5 g hydroxocobalamin for injection vial should be reconstituted with 200 ml of diluent using the supplied sterile transfer tip.

The recommended diluent is 0.9% Sodium Chloride Injection (0.9% NaCl). Lactated Ringers Injection and 5% Dextrose (D5W) Injection have also been found to be compatible with hydroxocobalamin and can be used if 0.9% NaCl is not readily available.

The line on the vial label represents 200 ml volume of diluent. After adding the diluent to the lyophilized powder, the vial should be repeatedly inverted or rocked, without shaking, for at least 60 seconds prior to infusion.

Hydroxocobalamin solutions should be visually inspected for particles and colors prior to administration.

If the reconstituted solution is not dark red in color or if particulate matter is observed after the solution has been properly mixed, the solution should be discarded.

An anti-migraine remedy

Hydroxocobalamin has been identified as a nitric oxide scavenger, an essential muscle regulator that also acts as a free radical.

Too much nitric oxide can cause swelling and discomfort, especially in the brain. One study found that hydroxocobalamin is effective in reducing the frequency and duration of migraines.