The commonly referenced therapeutic range of 0.25-0.5 mg daily (250-500 mcg) extrapolates from the effective rat dose of approximately 10 mcg/kg body weight
Severe or prolonged B12 deficiency can lead to a range of neurological manifestations, including peripheral neuropathy, which may present as pain, paraesthesia (pins and needles), or altered sensation in the extremities
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But some patients absorb less than expected and need additional sublingual or IM B12