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B12 supplementation in elderly patients with confirmed deficiency typically takes two main forms in the UK: Oral tablets (cyanocobalamin) Intramuscular injections (hydroxocobalamin, the standard form in the UK) NICE Clinical Knowledge Summary guidance recommends investigating B12 deficiency in older adults presenting with unexplained anaemia, neuropathy, cognitive impairment, or glossitis
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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Two patients in the reactive group presented with seizures
