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Causes Dietary deficiency strict vegetarian or vegan diet Pernicious anemia autoimmune destruction of stomach cells that absorb B12 Malabsorption disorders celiac disease, Crohns disease, atrophic gastritis Medications long-term use of proton pump inhibitors, metformin Surgical removal of stomach or intestines reduces absorption Signs and Symptoms Fatigue and weakness Pale or jaundiced skin Tingling or numbness in hands and feet (neuropathy) Difficulty walking or balance problems Memory loss, confusion, or mood changes Glossitis swollen, red tongue Shortness of breath, dizziness Complications (if untreated) Permanent nerve damage tingling, numbness, or difficulty walking Megaloblastic anemia large, immature red blood cells Cognitive decline or dementia in severe cases Diagnosis Blood tests low B12 levels, high homocysteine and methylmalonic acid Complete blood count (CBC) shows anemia Intrinsic factor antibodies if pernicious anemia is suspected Treatment Vitamin B12 supplementation: Oral B12 tablets for mild deficiency Intramuscular B12 injections for severe deficiency or absorption problems Dietary sources: Meat, fish, poultry, eggs, dairy products Fortified cereals or plant-based milk for vegetarians Vitamin B12 deficiency can cause anemia and nerve damage

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His goal was to get to a healthy weight of 190 where he can gain confidence, look healthier, feel healthier, and be a good motivation for his family

Expert Care: Administered by trained professionals in a clean, safe, and comfortable environment

Sollertinskaya, T

Determine creatinine clearance before each dose and periodically monitor renal function during treatment with Pemetrexed Injection