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By adjusting the dose and infusion protocol, healthcare providers can improve treatment results for patients with B12 deficiency

Intravenous and injectable vitamins are growing in popularity, not just for use on patients who have a known deficiency for a vitamin, but due to the known benefits of receiving these vitamins straight into the bloodstream

Two downstream consequences are mechanistically central: nicotinamide is preserved for re-entry into the NAD+ salvage pathway (raising intracellular NAD+ availability), and SAM is preserved for other methylation reactions

The fix is documentation

A 2024 critical review noted that unexpectedly high B12 levels can be further investigated by a clinician if needed, preferably by directly measuring the carrier proteins haptocorrin and transcobalamin rather than relying on the commonly ordered PEG precipitation test, which the authors found nonspecific and potentially misleading (Fedosov, 2024)

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