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Neurological symptoms often develop gradually and may include: Paraesthesia : tingling or 'pins and needles' sensations, typically starting in the feet and hands Numbness : reduced sensation in the extremities, which may affect balance and coordination Burning pain : particularly in the feet, often worse at night Weakness : muscle weakness and difficulty walking Balance problems : unsteady gait and increased fall risk due to proprioceptive impairment Cognitive changes : memory problems, confusion, difficulty concentrating, and mood disturbances Haematological signs may accompany neurological symptoms and include fatigue, weakness, pallor, and shortness of breath due to megaloblastic anaemia

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3.4 Changes in serum homocysteine by supplementation route and dosage Analysis of 10 comparisons showed that vitamin B12 supplementation was associated with a mean reduction of 35.8% in serum homocysteine concentrations (Supplementary Table S5)

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Integrity of the Medication Finally, proper storage of bacteriostatic water for injection is also necessary to keep the medication intact that has been reconstituted in it