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Guideline 2: Specialized Dosing for Pernicious Anemia Treating pernicious anemia needs a special vitamin B12 plan

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Volume: ~0.17 mL with an insulin syringe (29-31 gauge) Timing: Once weekly, same day each week in most reported protocols IM injection community sources do not describe IM protocols, citing concern over faster absorption Reconstitution Quick Reference The following reflects dilution ratios documented in community reconstitution sources: Math: 3 mg / 2 mL = 1.5 mg/mL = 1,500 mcg/mL

Metabolic pathways: B12 is a cofactor in two critical reactions: Methylmalonyl-CoA mutase: Converts methylmalonyl CoA (from odd-chain fatty acids and some amino acids) into succinyl-CoA, which enters the Krebs (TCA) cycle to make ATP (cellular energy)