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The evaluation must meet standard of care requirements: history, relevant labs, and documented clinical reasoning

Other signs may include shortness of breath, pale skin, stomach problems, such as constipation, diarrhea or gas, or nerve problems, like muscle weakness or tingling in fingers or toes. Over time, a deficiency of B12 can cause problems with balance, confusion, depression, poor memory and possibly dementia, and it can even cause permanent damage to the nervous system, Somers says

Nausea, mild abdominal discomfort, and occasional vomiting are frequent, usually mild to moderate, and typically improve over several weeks as the body adjusts to the medication