vitamin-b-12 and Hypotension

Elevated hydrogen sulfide (H. In adults with septic shock, is comparing high-dose IV hydroxocobalamin with placebo feasible?. We conducted a phase 2 single-center, double-blind, allocation-concealed, placebo-controlled, parallel-group pilot randomized controlled trial comparing high-dose IV hydroxocobalamin with placebo in critically ill adults with septic shock. Patients meeting Sepsis 3 criteria were randomized 1:1 to receive a single 5-g dose of high-dose IV hydroxocobalamin or equivalent volume 0.9% saline solution as placebo. The primary outcome was study feasibility (enrollment rate, clinical and laboratory compliance rate, and contamination rate). Secondary outcomes included between-group differences in plasma H. 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 H. This pilot trial established favorable feasibility metrics. Consistent with the proposed mechanism of benefit, high-dose IV hydroxocobalamin compared with placebo was associated with reduced vasopressor dose and H. ClinicalTrials.gov; No.: NCT03783091; URL: www.. gov.

Topics: Adult; Double-Blind Method; Humans; Hydroxocobalamin; Hypotension; Pilot Projects; Shock, Septic; Vasoconstrictor Agents; Vitamin B 12

The choice between hemodiafiltration (HDF) or high-flux hemodialysis (HD) to treat end-stage kidney disease remains a matter of debate. The duration of recovery time after treatment has been associated with mortality, affects quality of life, and may therefore be important in informing patient choice. We aimed to establish whether recovery time is influenced by treatment with HDF or HD.. Randomized patient-blinded crossover trial.. 100 patients with end-stage kidney disease were enrolled from 2 satellite dialysis units in Glasgow, United Kingdom.. 8 weeks of HD followed by 8 weeks of online postdilution HDF or vice versa.. Posttreatment recovery time, symptomatic hypotension events, dialysis circuit clotting events, and biochemical parameters.. Patient-reported recovery time in minutes, incidence of adverse events during treatments, hematology and biochemistry results, quality-of-life questionnaire.. There was no overall difference in recovery time between treatments (medians for HDF vs HD of 47.5 [IQR, 0-240] vs 30 [IQR, 0-210] minutes, respectively; P=0.9). During HDF treatment, there were significant increases in rates of symptomatic hypotension (8.0% in HDF vs 5.3% in HD; relative risk [RR], 1.52; 95% CI, 1.2-1.9; P<0.001) and intradialytic tendency to clotting (1.8% in HDF vs 0.7% in HD; RR, 2.7; 95% CI, 1.5-5.0; P=0.002). Serum albumin level was significantly lower during HDF (3.2 vs 3.3g/dL; P<0.001). Health-related quality-of-life scores were equivalent.. Single center; mean achieved HDF convection volume, 20.6L.. Patients blinded to whether they were receiving HD or HDF in a randomized controlled crossover study reported similar posttreatment recovery times and health-related quality-of-life scores.

Topics: Aged; Aged, 80 and over; beta 2-Microglobulin; Betaine; Cross-Over Studies; Female; Health Status; Hemodiafiltration; Humans; Hypotension; Interleukin-6; Kidney Failure, Chronic; Male; Middle Aged; Parathyroid Hormone; Phosphates; Potassium; Quality of Life; Recovery of Function; Renal Dialysis; Single-Blind Method; Time Factors; United Kingdom; Urea; Vitamin B 12

Topics: Adrenal Glands; Adult; Aged; Clinical Trials as Topic; Convalescence; Drug Combinations; Drug Evaluation; Female; Humans; Hypotension; Liver Extracts; Male; Middle Aged; Tissue Extracts; Vitamin B 12; Vitamin B Complex

The azide anion (N. We found cobinamide bound azide with a moderate affinity (K. We conclude cobinamide likely acted by neutralizing both oxidative stress and nitric oxide, and that it should be given further consideration as an azide antidote.

Topics: Adenosine Triphosphate; Animals; Antidotes; Azides; Cobamides; Drosophila melanogaster; Electron Transport Complex IV; Hypotension; Mammals; Mice; Nitric Oxide; Vitamin B 12; Vitamins

Vitamin B

Topics: Adult; Diagnosis, Differential; Diet, Vegetarian; Fever; Humans; Hypotension; Male; Pancytopenia; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

The cobalt atom of hydroxocobalamin (OHC) binds cyanide and nitric oxide (NO) and OHC attenuates vascular responses to NO in vitro. NO mediates the hypotension of endotoxemia. Thus, we tested the postulate that OHC may attenuate the acute phase hypotension and toxicity associated with administration of Escherichia coli endotoxin (LPS). Rats were given OHC (20 mg/kg i.v.) or phosphate-buffered saline (PBS, 1 ml/kg i.v.) 30 min before or 15 min after giving LPS (0.8 mg/kg i.v.). Administration of OHC to PBS-treated control rats did not affect mean arterial pressure (MAP), heart rate or the plasma or urine content of the reactive nitrogen intermediates nitrate and nitrite (RNI). LPS decreased MAP by 50 mm Hg in PBS-treated rats and increased the plasma and urinary content of RNI. Administration of OHC to PBS-treated rats did not affect MAP or RNI. However, treatment with OHC before or after giving LPS attenuated LPS-induced hypotension and increases in plasma RNI and enhanced LPS-induced urinary excretion of RNI. OHC (20 mg/kg i.p.) or cyanocobalamin (10 mg/kg i.p.) given to Swiss-Webster mice 30 min before giving LPS (16 mg/kg i.p.) decreased the 24-hr mortality of LPS from 80 to 50% and the 36- and 96-hr mortality from 100 to 60% (OHC) or 70% (cyanocobalamin). Urine obtained from conscious rats given LPS (5 mg/kg i.p.) and OHC (20 mg/kg i.p.) exhibited a UV-visible absorbance spectrum with absorbance peaks characteristic of that formed after coincubation of NO and OHC.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Blood Pressure; Hydroxocobalamin; Hypotension; Lipopolysaccharides; Male; Mice; Mortality; Nitric Oxide; Rats; Rats, Sprague-Dawley; Spectrophotometry; Vitamin B 12

In view of evidence suggesting possible participation of cobalamin in cyanide metabolism, the effects of sodium nitroprusside (SNP) infusion on blood cyanide and plasma thiocyanate levels and serum vitamin B12 levels were examined in ten patients undergoing major orthopedic procedures. Whole blood cyanide concentrations increased significantly (P less than 0.001) from 3.6 +/- 1.1 to 65.7 +/- 16.2 micrograms/dl, and total serum B12 values decreased significantly (P less than 0.005) from 482 +/- 56 to 267 +/- 42 pg/ml, three hours after SNP therapy. Plasma thiocyanate did not change. Cyanide released from SNP converts hydroxocobalamin to cyanocobalamin, which is readily excreted in urine. These variables were not changed in six patients (control) who received trimethaphan. In vitro experiments revealed that none of the serum factor(s) nor nitroprusside interfered with the assay of B12. Hydroxocobalamin may be an appropriate adjunct during SNP therapy.

Topics: Adolescent; Adult; Cyanides; Ferricyanides; Humans; Hypotension; Nitroprusside; Thiocyanates; Trimethaphan; Vitamin B 12

Topics: Acidosis; Adult; Cyanides; Cyanosis; Gastric Lavage; Gastrointestinal Hemorrhage; Humans; Hydrogen Cyanide; Hydrogen-Ion Concentration; Hydroxocobalamin; Hypotension; Liver; Middle Aged; Poisoning; Suicide; Time Factors; Vitamin B 12

The infusion of sodium nitroprusside during surgical operations produced plasma levels of cyanide of up to four times the control value. Plasma thiocyanate showed little change except during prolonged infusion of the drug, but total plasma B(12) tended to fall, as did methylcobalamin. Other cobalamins showed little change after nitroprusside infusion for short periods. During longer infusions the ratio of methylcobalamin to adenosyl + hydroxocobalamin fell and cyanocobalamin concentrations were high.

Topics: Anesthesia, General; Child; Cyanides; Female; Ferricyanides; Humans; Hydroxocobalamin; Hypotension; Hypotension, Controlled; Infusions, Parenteral; Middle Aged; Thiocyanates; Vitamin B 12

Topics: Adjustment Disorders; Adolescent; Adrenal Cortex Hormones; Adult; Aged; Asthenia; Biliary Tract Diseases; Female; Gastrointestinal Diseases; Hematologic Diseases; Humans; Hypotension; Leukemia; Lung Diseases; Male; Middle Aged; Porphyrins; Pyridoxine; Urologic Diseases; Vitamin B 12

Topics: Ascorbic Acid; Aspirin; Brain Concussion; Cerebral Ventriculography; Cortisone; Diphenhydramine; Electroencephalography; Headache; Hematoma, Subdural; Histamine H1 Antagonists; Humans; Hypotension; Injections, Intravenous; Procaine; Radiography; Spinal Puncture; Thiamine; Unconsciousness; Vision Disorders; Vitamin B 12

Topics: Adult; Aged; Analgesics; Chlorpromazine; Female; Humans; Hypotension; Injections, Intramuscular; Male; Middle Aged; Procaine; Thiamine; Trigeminal Neuralgia; Vitamin B 12

Topics: Anemia; Anemia, Pernicious; Folic Acid; Hematinics; Humans; Hypotension; Hypotension, Orthostatic; Posture; Vitamin B 12

The hypotensive action of veratrum viride given intravenously was studied in 24 patients, 22 of them hypertensive and 2 normotensive. Vasodepression of considerable but variable degree was obtained in all patients. Maximum hypotension occurred 8 to 15 minutes after injection and relative hypotension usually lasted at least two hours. In four patients subnormal hypotension occurred but there were no clinical manifestations of shock. The blood pressure rose promptly when pressor drugs were administered.A dose of 0.3 to 0.5 mg. brought about a satisfactory decrease in blood pressure. The degree of decrease was affected by the speed of administration and in a few patients by idiosyncratic sensitivity to the drug. Veratrum has an extravagal action on the pulse rate, and in that and other respects resembles digitalis. Veratrum should be given with caution to digitalized patients. Atropine reduced but did not abolish the hypotensive effect of veratrum, and was more effective when given before veratrum. This indicates that the parasympathomimetic action of veratrum is important in the mechanism of blood pressure reduction.

Topics: Blood Pressure; Cardiovascular System; Heart Rate; Hematinics; Hypertension; Hypotension; Injections, Intravenous; Parasympathomimetics; Pharmaceutical Preparations; Plant Extracts; Vasoconstrictor Agents; Veratrum; Veratrum Alkaloids; Vitamin B 12