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Whilst vitamin B12 toxicity is exceptionally rare, very high levels from supplements or injections have been associated with skin reactions such as acne-like eruptions
Recommended investigations include: Full blood count with blood film examination Serum vitamin B12 level Serum folate (to exclude combined deficiency) Intrinsic factor antibodies Thyroid function tests (autoimmune association) Consider MMA and homocysteine if diagnosis uncertain and available Neurological examination should be performed in all patients, assessing for peripheral neuropathy, proprioception loss, and signs of subacute combined degeneration of the spinal cord
Treating this deficiency can result in improved energy and a sense of well-being improvement
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