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This section eliminates that confusion entirely

Abstract Administration of high-dose hydroxocobalamin, or vitamin B12, is an emerging, targeted rescue therapy for the treatment of refractory vasoplegic shock

Treatment with vitamin B12 may unmask this condition

Baba Y, Higa JK, Shimada BK, Horiuchi KM, Suhara T, Kobayashi M, Woo JD, Aoyagi H, Marh KS, Kitaoka H, et al

for example, a higher intracellular intake can be driven by adrenergic stimulation, insulin, or alkalosis

While high ALP alone was associated with a moderate risk of mortality, simultaneous elevation of both enzymes was associated with a higher risk of mortality