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When B12 levels are equivocal, additional testing with methylmalonic acid (MMA) and homocysteine levels can provide greater diagnostic accuracy, as both are elevated in true B12 deficiency
If side effects do occur, they are generally mild and may include: Pain, discomfort, swelling, or redness at the injection site Diarrhea Headache Bloating Nausea Numbness or tingling Serious side effects are rare and may include: Confusion Dizziness or fainting Muscle pain, cramps, or weakness Extreme thirst Facial flushing Frequent urination Palpitations Fatigue Difficulty breathing Coughing or noisy breathing (wheezing) Extreme pain, swelling, warmth or tenderness in one leg Difficulty swallowing Rash Itching over the body If you experience serious side effects, contact your doctor right away
These symptoms often correlate with other gastrointestinal effects and may be particularly noticeable after meals due to delayed gastric emptying
A discussion with your healthcare provider can also help you decide, considering your health needs and lifestyle
Serum cobalamin levels do not strictly correlate with physiologic deficiency, in part because traditional assays measure total serum cobalamin, even though the fraction bound to transcobalamin II (holotranscobalamin II) is physiologically most important
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