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Exposure per milligram is higher, particularly in lighter East Asian users, while the smaller fat reserve makes a 75:25 fat-to-lean split more consequential

For patients with severe B12 deficiency, we may recommend an initial loading phase of daily or weekly injections to quickly restore B12 levels

Revised 2023

Sensory Symptoms Numbness, tingling, or pins and needles (paresthesia) typically distal/stocking-glove in polyneuropathy Burning pain, allodynia, hyperalgesia common in small-fiber predominant neuropathy and CIDP Loss of proprioception and vibration sense sensory ataxia, positive Romberg sign Loss of pain/temperature sensation (small fiber) risk of unnoticed wounds Motor Symptoms Distal muscle weakness (foot drop in peroneal neuropathy, wrist drop in radial neuropathy) Atrophy of intrinsic hand muscles (ulnar/median neuropathy) Hyporeflexia or areflexia (ankle jerks lost early in length-dependent polyneuropathy) Fasciculations in severe axonal loss Autonomic Symptoms Orthostatic hypotension, dizziness on standing Gastroparesis, constipation or diarrhea, nausea Neurogenic bladder (hesitancy, retention, incontinence) Anhidrosis or gustatory sweating Sexual dysfunction