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If a patient has specific or red flag features B 12 deficiency testing should be initiated (see Figure 1: B 12 Test Result Review and Process Algorithm for Patients with Risk Factor for B 12 Deficiency * and/or Non-specific ** or Specific Symptom of B 12 Deficiency )

studied a cohort of 176,702 German children and found 33 children suffered from vitamin B12 deficiency with a prevalence of approximately 1:5355 [85]

NAD injections can boost vitality, mental clarity, and support long-term wellness, especially as natural NAD levels decline with age

There are no other absolute contraindications reported for hydroxocobalamin use in deficiency states, but caution is advised in individuals with conditions such as early Lebers optic neuropathy (a rare hereditary optic atrophy) due to the theoretical risk of worsening vision