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5.8 Cyanocobalamin (Vitamin B-12) Deficiency Daily treatment with any acid-suppressing medications over a long period of time (e.g., longer than 3 years) may lead to malabsorption of cyanocobalamin (vitamin B-12) caused by hypo- or achlorhydria

For example, adults over 60 are more prone to deficiency due to decreased stomach acid production

A common approach is 2-3 mL BAC water per 10 mg vial

Advances in treatment over the last 20 years has led to the development of antibody and small molecule medications which are very effective and with fewer side-effect or contra-indications to taking

These laboratory abnormalities may progress, may remain unchanged or may be transient with continuing therapy

Metabolism is not a fixed number