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Upon binding, it activates a Gq-protein signaling cascade, leading to the production of inositol triphosphate (IP3) and diacylglycerol (DAG)

Peer review Peer review information Communications Biology thanks Dhaval K Shah and the other, anonymous, reviewer(s) for their contribution to the peer review of this work

That means: Hypokalemia can develop or worsen which can lead to: Cardiac arrhythmias Muscle weakness QT prolongation In severe cases, sudden cardiovascular instability This is a classic board-style pearl that many clinicians forget because B12 feels benign. But in profoundly deficient patientsespecially those with severe megaloblastic anemiarepletion is metabolically active treatment

Also, consider the Law of Diminishing Returns

However, increasing oral supplement doses (within safe limits) while awaiting medical review is generally considered safe, as B12 has very low toxicity and excess is excreted through the kidneys

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