Cobalamin deficiency in elderly patients: a personal view
Certain patients, such as those with a hereditary eye condition called Lebers disease, should avoid B12 injections altogether, as these may worsen symptoms
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In part, this reflects excitation/inhibition balance and classical aminergic neuromodulatory tone in the brain, both of which are deranged by excess nitrogen and can ultimately cause excitotoxicity if nitrogen imbalances are not promptly addressed (Rangroo Thrane et al., 2013)
In severe cases, the neurological complications of pernicious anemia can lead to death hence the name, "pernicious", meaning deadly