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Common signs include: Fatigue and weakness Numbness or tingling in the hands and feet Difficulty walking or balance problems Mood changes, such as depression or anxiety Cognitive difficulties, including memory loss or confusion If not treated, a B12 deficiency can cause serious problems

Vitamin deficiencies, especially B12, are common in adults and children

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Additionally, individuals with certain medical conditions like Leber's disease, low potassium levels, optic nerve disease, or liver/kidney issues should inform their healthcare provider before starting treatment

Toluidine blue may interfere with the estimation of methaemoglobin by some methods (Smith, 1971) (see chapter 10)

The implications of this in people with Down syndrome need additional study