Cautious use of parenteral cyanocobalamin is also recommended in patients with renal impairment, including premature neonates, because of the possibility of greater aluminum accumulation, which may cause central nervous system and bone toxicity
Higher concentrations would be more effective at preventing bacterial growth but would cause tissue irritation at injection sites
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High-quality human clinical trials are lacking
This was because hydroxocobalamin produced by bacteria was changed to cyanocobalamin during purification in activated charcoal columns after separation from the bacterial cultures (because cyanide is naturally present in activated charcoal)
Studies suggest that an injection of Butaphosphan and Vitamin B12 on the day of calving and one day later can decrease the prevalence of subclinical ketosis during the week after calving in mature dairy cows
