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Other reactions warranting urgent GP contact include: Unexplained muscle weakness or cramping Persistent vomiting or severe abdominal pain Signs of hypokalaemia (low potassium) during initial treatmentmuscle weakness, irregular heartbeat, or severe fatigue In patients with severe, longstanding B12 deficiency, rapid correction can occasionally precipitate hypokalaemia as new red blood cells are produced, consuming available potassium

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NICE Clinical Knowledge Summaries advise oral cyanocobalamin for dietary deficiency, while intramuscular hydroxocobalamin is recommended for pernicious anaemia or malabsorption syndromes