[20] For nutritional deficiency without intrinsic-factor loss, shorter courses-such as 30-100 mcg intramuscularly daily for five to ten days followed by 100-200 mcg monthly-are often sufficient
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Oral B12 (50150 g daily) may be appropriate for dietary deficiency without neurological involvement, but intramuscular hydroxocobalamin injections remain first-line treatment in the UK for patients with nerve symptoms or malabsorption conditions
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One possible explanation is that low serum vitamin B12 levels would trap folate as 5-methyltetrahydrofolate, prevent the generation of methionine from homocysteine, and therefore reduce protein synthesis and lean tissue deposition
