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[51] Diagnosis [edit] According to one review: "At present, no 'gold standard' test exists for the diagnosis of vitamin B 12 deficiency and as a consequence the diagnosis requires consideration of both the clinical state of the patient and the results of investigations." [52] The vitamin deficiency is typically suspected when a routine complete blood count shows anemia with an elevated mean corpuscular volume (MCV)

10.1016/j.drugalcdep.2007.04.004 40 OkanoM.SatoM.KageyamaS

Impairment can affect energy metabolism and nerve function

Heffernan, M

After reconstitution, gently swirl do not shake until the powder fully dissolves

But because the FDA has not approved them, selling them for human use is illegal under U.S