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[DOI] [PubMed] [Google Scholar] 32.Torres-Santiago L, Mauras N, Hossain J, Weltman AL, Darmaun D

In deficiency, the body makes abnormally large, inefficient cells (megaloblastic anemia)

Serious Warning Signs Severe abdominal pain: Especially if sudden onset, radiating to back, or with vomiting (possible pancreatitis, occurred in 0.3% of patients) Severe vomiting: If unable to keep any fluids down for 24 hours (dehydration risk) Signs of dehydration: Dark urine, dizziness on standing, confusion, decreased urination (acute kidney injury risk) Vision changes: Blurred vision, eye pain (rare but requires evaluation) Rapid heart rate: Persistent heart rate over 100 at rest (some increase normal, average 2-4 bpm, but sustained tachycardia needs evaluation) Suicidal thoughts: Any thoughts of self-harm (under 1% occurrence but requires immediate support) Severe allergic reaction: Difficulty breathing, throat swelling, severe rash (anaphylaxis requires emergency care) Lump in neck: Especially with difficulty swallowing (thyroid concern, rare but part of class warning) Trust your instincts