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The British National Formulary (BNF), for example, differentiates the prescription of hydroxocobalamin according to presenting symptoms, eg, For neurological involvement, it is advised to administer hydroxocobalamin by intramuscular injection, initially 1 mg once daily on alternate days until no further improvement, then 1 mg every 2 months. In the Netherlands, pharmacotherapeutic guidelines51 recommend (for the same neurological symptoms or abnormalities) administration of 1000 mcg once or twice weekly for up to two years

In one such case, a 71-year-old man was diagnosed with severe B12 deficiency due to pernicious anemia

According to the NIH Office of Dietary Supplements, B12 plays a key role in: Making red blood cells and preventing megaloblastic anemia Maintaining healthy nerve function and the myelin sheath that protects nerves DNA synthesis Supporting brain function and preventing cognitive decline Converting food into energy (cellular metabolism) Because B12 is found almost exclusively in animal products meat, fish, dairy, and eggs certain groups of people are at much higher risk of deficiency than others

This decyanation process is demanding: Although the amount of cyanide is considered toxicologically insignificant, humans must remove and detoxify the cyanide molecule, reduce the cobalamin to its usable +1 oxidation state, and then enzymatically convert the cobalamin into one of two metabolically active coenzyme forms

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