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Description
That is why different reconstitution volumes produce different dosing charts

Sensory Symptoms Numbness, tingling, or pins and needles (paresthesia) typically distal/stocking-glove in polyneuropathy Burning pain, allodynia, hyperalgesia common in small-fiber predominant neuropathy and CIDP Loss of proprioception and vibration sense sensory ataxia, positive Romberg sign Loss of pain/temperature sensation (small fiber) risk of unnoticed wounds Motor Symptoms Distal muscle weakness (foot drop in peroneal neuropathy, wrist drop in radial neuropathy) Atrophy of intrinsic hand muscles (ulnar/median neuropathy) Hyporeflexia or areflexia (ankle jerks lost early in length-dependent polyneuropathy) Fasciculations in severe axonal loss Autonomic Symptoms Orthostatic hypotension, dizziness on standing Gastroparesis, constipation or diarrhea, nausea Neurogenic bladder (hesitancy, retention, incontinence) Anhidrosis or gustatory sweating Sexual dysfunction

This can cause methyl trapping, where the excess methylfolate is unable to be utilised in the methionine cycle (through the MTR enzyme) as usable B12 levels are too low

Follow healthcare provider recommendations: Working closely with a healthcare provider to determine the optimal dosing and frequency of B12 injections based on individual needs and health status can help maximize their effectiveness
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The matrix below covers every common scenario before we go deeper on the ones that cause the most denials
