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It includes 1-5 intramuscular or subcutaneous injections of 1000 mcg crystalline cyanocobalamin daily, followed by oral doses of 1000-2000 mcg/day Parenteral administration should be reserved for those with significant neurological symptoms NICE guideline: Vitamin B 12 deficiency in over 16s: diagnosis and management: Malabsorption as the confirmed or suspected cause of vitamin B 12 deficiency: Offer replacement to people if: lifelong intramuscular vitamin B12 Autoimmune gastritis is the cause They have had a total gastrectomy They have had a complete terminal ileal resection If the person has a vitamin B 12 deficiency because of malabsorption that is not caused by autoimmune gastritis, or a total gastrectomy or complete terminal ileal resection (for example, malabsorption caused by coeliac disease, partial gastrectomy or some forms of bariatric surgery): Offer vitamin B 12 replacement and Consider intramuscular instead of

| Concentration | BAC Water | Doses at 1.0mg | Doses at 2.4mg | |---------------|-----------|----------------|----------------| | 5mg/mL | 2.0mL | 10 doses | ~4 doses | | 2.5mg/mL | 4.0mL | 10 doses | ~4 doses | **Best practice:** 2.0mL BAC water gives a clean 5mg/mL concentration