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Epidemiology: High levels of vitamin B12 were found in: Causes: Excessive supplementation (a direct increase in plasma vitamin B12 by excess intake or administration) Increased release of vitamin B12 from tissue stores (liberation from an internal reservoir): Solid tumors (especially hepatic or hematologic malignancies) Liver metastases Increased binding proteins: 7 Excess production: Liver disease (e.g., hepatitis, cirrhosis, hepatocellular carcinoma) damaged hepatocytes release haptocorrin (transcobalamin I) and B12 into circulation Myeloproliferative disorders these increase granulocyte production, which leads to more haptocorrin (transcobalamin I/III), a B12-binding protein produced by proliferating myeloid cells

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Unsaturated VPA metabolites (4-en-VPA and 2, 4-dien-VPA) are potent inducers of microvesicular steatosis in rats, whereas VPA itself failed to induce discernible liver lesions at near lethal doses [60]

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