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High-Dose I.V. Hydroxocobalamin in Septic Shock

Phase 2 trial investigators find support for the hypothesis that high-dose I.V. hydroxocobalamin (vitamin B12) can reduce elevated hydrogen sulfide levels in critically ill patients in septic shock. This is the first “proof of concept” that this intervention could restore vascular tone and accentuate recovery.

In the Intravenous Hydroxocobalamin in Septic Shock Trial, 20 participants meeting Sepsis 3 criteria were randomized to receie a single 5-g dose of high-dose IV hydroxocobalamin or equivalent volume 0.9% saline solution as placebo. Based on a primary outcome of study feasibility (enrollment rate, clinical and laboratory compliance rate, and contamination rate), the study showed: “Twenty patients were enrolled over 19 months, establishing an enrollment rate of 1.05 patients per month. Protocol adherence rates were 100% with zero contamination. In the high-dose IV hydroxocobalamin group, compared to placebo, there was a greater reduction in vasopressor dose between randomization and postinfusion (–36% vs 4%, P < .001) and randomization and 3-h postinfusion (–28% vs 10%, P = .019). In the high-dose IV hydroxocobalamin group, the plasma H2S level was reduced over 45 mins by –0.80 ± 1.73 μM, as compared with –0.21 ± 0.64 μM in the placebo group (P = .3).”

Source: Chest