From the Guidelines
For a person with a vitamin B12 level of 179 pg/mL, the recommended initial treatment is typically 1 mg of hydroxocobalamin injected intramuscularly three times a week for 2 weeks, followed by maintenance treatment with 1 mg intramuscularly every 2–3 months for life, as per the guidelines from the British Obesity and Metabolic Surgery Society 1.
Key Considerations
- The patient's current B12 level is below the normal range, indicating a deficiency that requires immediate treatment.
- The treatment regimen should be adjusted based on the presence or absence of neurological involvement, with more frequent dosing for those with neurological symptoms.
- Maintenance therapy is crucial to prevent recurrence of deficiency and should be continued lifelong, especially if the underlying cause of deficiency is ongoing.
Treatment Regimen
- Initial treatment: 1 mg of hydroxocobalamin injected intramuscularly three times a week for 2 weeks.
- Maintenance treatment: 1 mg of hydroxocobalamin injected intramuscularly every 2–3 months for life.
Monitoring and Follow-up
- Regular blood tests should be conducted to monitor B12 levels and ensure they return to the normal range.
- Patients should be monitored for improvement in symptoms such as fatigue, tingling in hands and feet, or cognitive issues.
Important Notes
- It is essential to consult with a healthcare provider before starting treatment, as they may adjust the regimen based on individual factors and response to therapy.
- The guidelines from the British Obesity and Metabolic Surgery Society 1 and the NICE guideline summary 1 provide the most up-to-date recommendations for treating vitamin B12 deficiency.
From the Research
Vitamin B12 Injection Dose
The recommended vitamin B12 injection dose is not explicitly stated in the provided studies for a person with a current B12 level of 179. However, the studies suggest the following:
- High oral doses of B12 (1000 mcg and 2000 mcg) are as effective as intramuscular administration in achieving haematological and neurological responses 2.
- Oral administration of high-dose vitamin B12 (1 to 2 mg daily) is as effective as intramuscular administration for correcting anemia and neurologic symptoms 3.
- Intramuscular therapy leads to more rapid improvement and should be considered in patients with severe deficiency or severe neurologic symptoms 3.
Key Points to Consider
- The route of administration (oral or intramuscular) may depend on the severity of the deficiency and the presence of neurologic symptoms 3.
- High-dose oral vitamin B12 may be as effective as intramuscular administration in correcting vitamin B12 deficiency 2, 3.
- The choice of formulation (methylcobalamin, cyanocobalamin, or hydroxocobalamin) may also be considered, as they have distinct metabolic fates and functions 4.
Treatment Options
- Oral vitamin B12 (1 to 2 mg daily) may be considered for patients with mild to moderate deficiency 3.
- Intramuscular vitamin B12 may be considered for patients with severe deficiency or severe neurologic symptoms 3.
- Sublingual administration of vitamin B12 may also be an effective treatment option, especially in children 5.