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Populations to avoid: Pregnant and breastfeeding individuals, individuals with active neuroendocrine conditions, and those on ACTH-axis medications should not use DSIP without specialist guidance

Special Scenarios Post-COVID generalized weakness Documentation must be separate: active infection vs post-infectious recovery Objective strength deficits functional impairment and safety concerns structured plan with measured progress Weakness in older adults Older patients require clear separation between: generalized weakness (M62.81) confirmed sarcopenia (M62.84) Neurologic causes of weakness when present Fall risk documentation strengthens medical necessity when accurate and specific

Mechanism of Action Tissue repair: Supports regeneration and recovery in lab studies

10.1126/science.1077209 Science 19 CaiQ.JeongY

Darmaun D, Smith SD, Sweeten S, Sager BK, Welch S, Mauras N

Prehospital administration of hydroxocobalamin for smoke inhalation - associated cyanide poisoning: 8 years of experience in the Paris Fire Brigade