Vitamin B 12 -responsive severe leukoencephalopathy and autonomic dysfunction in a patient with normal serum B 12 levels J Neurol Neurosurg Psychiatry 2010;81:1369-71
Serious events (organ toxicity, hormone suppression) have not been documented, but long-term safety data are lacking
Monitoring recommendations: Baseline investigations: Full blood count, B12 level, folate, and intrinsic factor antibodies (if pernicious anaemia suspected) During initial treatment: Potassium monitoring in severe deficiency (risk of hypokalaemia) Follow-up: Repeat full blood count after 8 weeks to confirm haematological response Long-term: Annual review to ensure compliance with maintenance injections
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