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Cell Biochem Biophys 65:473483

Without testing, there is no way to distinguish between B12 deficiency and other causes of similar symptoms, no way to determine the severity of deficiency, and no way to select the most appropriate delivery method

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Other reactions warranting urgent GP contact include: Unexplained muscle weakness or cramping Persistent vomiting or severe abdominal pain Signs of hypokalaemia (low potassium) during initial treatmentmuscle weakness, irregular heartbeat, or severe fatigue In patients with severe, longstanding B12 deficiency, rapid correction can occasionally precipitate hypokalaemia as new red blood cells are produced, consuming available potassium

Common effects usually mild and often worst during titration include nausea, vomiting, diarrhea, constipation, abdominal pain, upset stomach, headache, and fatigue