This protocol addresses neurological manifestations of vitamin B12 deficiency in patients whose deficiency is attributable to recreational nitrous oxide use — a context that shapes the clinical approach to replacement therapy.
Recreational nitrous oxide use can lead to vitamin B12 deficiency and subsequent neurological manifestations. Management involves vitamin B12 replacement, with the choice of route guided by clinical judgement and the patient's preference.
When oral replacement is no longer adequate, the structured approach involves transitioning to an injection-based route of vitamin B12 administration. The complete decision pathway — including when to escalate and how to manage ongoing care — is detailed in the full protocol.
Offer either intramuscular or oral vitamin B12 replacement to people with a vitamin B12 deficiency caused by recreational nitrous oxide use, based on clinical judgement and the person's preference.
if they are already taking the maximum licensed dosage for oral treatment, switch to intramuscular vitamin B12 injections.
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