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Signs of the disease often include: Constitutional symptoms: fatigue, lethargy, loss of appetite, and weight loss Neurological changes: headaches, confusion, difficulty focusing, memory loss, cognitive decline, numbness, and balance issues Psychiatric effects: emotional instability, depression, personality changes, psychosis Otolaryngologic symptoms: loss or change in the sense of taste, inflammation of the tongue Cardiopulmonary indications: palpitations, difficulty breathing Gastrointestinal problems: indigestion, diarrhea, reduced appetite Patients with advanced pernicious anemia may also have noticeable physical characteristics such as pale or yellowing skin, dry skin, tender tongue, and rapid heart rate

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Wear sterile gloves if you are administering the injection to someone else

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Bioorganic & Medicinal Chemistry Letters