This protocol addresses neurological manifestations in a person with suspected or confirmed vitamin B12 deficiency where the deficiency arises because the diet is lacking in vitamin B12.
Initial management involved oral vitamin B12 replacement, with the goal of increasing vitamin B12 concentrations and allowing symptoms to begin improving. When symptoms have not sufficiently improved and continue to interfere with normal daily activities, escalation to the next treatment step is indicated.
When the initial oral replacement has not produced sufficient symptom relief, an adjustment to the oral dosing strategy — taking treatment preferences into account — is a key part of the next step. The complete decision pathway is available in the full protocol.