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24 In a clinically symptomatic patient with specific features of B 12 deficiency, order a B 12 test, see Figure1: 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 for more detail

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Clinicians must also avoid intravenous administration in the presence of severe sino-atrial, atrioventricular, or intraventricular conduction block in the absence of functional pacemaker support, as well as in classic Adams-Stokes or Wolff-Parkinson-White syndromes, where suppression of accessory pathways may paradoxically precipitate fatal arrhythmias

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