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To achieve permanent results, 2-3 sessions spaced 4 weeks apart are generally required

[8] detoxification of acyl groups by forming acylcarnitine, which is then excreted to prevent the accumulation of potentially toxic fatty acyl intermediates

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Intramuscular (IM) B12 injections using hydroxocobalamin, the preferred licensed form in the UK are recommended when: Oral supplementation has failed to correct a documented deficiency The patient has difficulty adhering to daily oral regimens Serum B12 levels remain persistently low despite adequate oral dosing There is clinical evidence of neurological or haematological complications In line with BNF guidance, the standard IM regimen for confirmed deficiency without neurological involvement is a loading course of 1 mg hydroxocobalamin on alternate days for two weeks , followed by maintenance of 1 mg every three months

doi: 10.3181/0037972720743786 155 JinJHashizumeT