This patient's regimen of vitamin B12 injections was a sensible approach to management. B12 can be given orally if the patient prefers. Injection became universal practice because almost all cases of diagnosed B12 deficiency result from malabsorption. Nevertheless, even when the stomach does not produce intrinsic factor, vitamin B12 deficiency can often be corrected with very large oral doses-1,000 µg a day.
An estimated 1% of the oral dose crosses the gut mucosa by diffusion, which may be sufficient to reverse the deficiency. If injection is chosen as the route of administration, the costs and inconvenience of regular visits to the doctor's office can be obviated by teaching the patient or a relative to perform the injection.
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