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That means: Hypokalemia can develop or worsen which can lead to: Cardiac arrhythmias Muscle weakness QT prolongation In severe cases, sudden cardiovascular instability This is a classic board-style pearl that many clinicians forget because B12 feels benign. But in profoundly deficient patientsespecially those with severe megaloblastic anemiarepletion is metabolically active treatment

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Regular injections may be recommended to help maintain consistent nutrient levels over time

Professor Carmels numbers are consistent with what youd expect based on our own understanding of the metabolism of B12, meaning: 3 Months Is a Good Rule of Thumb Both clinical and electrophysiological signs had totally disappeared 3 months later on

A 2025 review in Pharmaceuticals put it bluntly: There are obvious differences between the physiologies of rodents and humans

You could contact your local CCG/Health Board and ask what guidelines on B12 treatment are currently being used in your area of UK