1. Hydroxocobalamin 1mg/ml Lynne Powell RN, MSc. IP. PgCEd.

2. Aims & objectives  To explore the facts about vitamin B12  Identify the sources of vitamin B12  Look at the complications caused by deficiency  Discuss the treatment of deficiency  Consider the administration of cobalamin

3. FACTS Vitamin B12 (cobalamin)  Is a water-soluable vitamin  Commonly known as the red vitamin  Can not be produced by the body  Found in food  Stored in the liver  Stores can last 3-5 years in the liver  Absorbed form the small bowel in the presence of intrinsic factor

5. What does it do?  Form and regenerate red blood cells  Promotes growth and appetite in children  Increase energy  Maintains a healthy nervous system  Improves memory, concentration and balance  Utilses fat, protein and carbohydrate

6. Deficiency of B12  Originally low levels were only detected when the patient became clinically ill  Prior to the discovery of treatment, it was a fatal condition  Modern tests are now used to diagnose the disease before it becomes clinically apparent  Without enough B12 your body can’t make enough red blood cells

8. Pernicious anaemia  Type of megaloblastic anaemia  Loss of gastric parietal cells (GPC)  GPC secrete intrinsic factor  Intrinsic factor = a protein essential for absorption of B12  B12 is surrounded by a protein that is separated in the presence of hydrochloric acid, b12 is then able to bind with IF

10. Treatment regimes for pernicious anaemia (BNF June 2014)  Hydroxocobalamin 1mg pernicious anaemia without neurological involvement – 1mg 3 times a week for 2 weeks then 1mg every 3 months  Hydroxocobalamin 1mg pernicious anaemia with neurological involvement – 1mg on alternate days until no further improvement, then 1mg every 2 months months Remember its not your role to prescribe, this is for your information only Is the regime documented in the notes?

11. Administration equipment 2ml syringe Selection of green and blue hypodermic needles ampule of hydroxocobalamin Cottonwool Tape or plaster (not always needed)

12. Name of drug ; hydroxocobalamin; cobalin H Pre administration check Colour of contents Batch number

17. NEXT 1.Change the hypodermic needle 1.Expel excess air, remove the needle cover 1.Inject into the deltoid muscle (slowly) 2.Remove the needle and dispose of the equipment as a whole into a yellow topped sharps box. Do NOT re-sheath a needle 3.Check the injection site; dress only if needed

19. Documentation  Patient identification; e.g. name, DOB, address, etc.  Has the treatment regime been documented in the notes???  The name of the drug and dose; e.g. hydroxocobalamin 1mg/ml  The batch number; e.g. BN 72315  The expiratory date; e.g. Exp. 03/2015  The site of injection; e.g. right arm  Date of next injection; give this information to the patient.