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The most frequent symptoms are: Developmental delays Anaemia Loss of appetite Chronic vomiting Weight loss Low brain volume Spasms/cramps Apathy Irritability In the most severe instance, vitamin B12 deficiency can lead to respiratory failures and coma (51)

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UK guidelines recommend monitoring clinical response and full blood count (typically at around 2 months) to ensure treatment adequacy, rather than routinely rechecking B12 levels after replacement has started

Additionally, B12 is essential for the conversion of homocysteine to methionine, preventing the accumulation of homocysteine, which is associated with cardiovascular risk