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22,23 In patients with a normal or low-normal serum vitamin B 12 level, complete blood count results demonstrating macrocytosis, or suspected clinical manifestations, a serum methylmalonic acid level is an appropriate next step 1,2,6,18 and is a more direct measure of vitamin B 12 's physiologic activity

Cortes-LedesmaCArruzaLSainz-VillamayorAMartnez-OrgadoJ

These drugs can cause serious side effects and can interact with other medications

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doi: 10.4103/2230-8210.131155

At the biochemical level extreme shifts in the NADH to NAD plus ratio can alter redox balance