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chronic liver disease and hepatitis may present with elevated levels Renal impairment : Reduced clearance can contribute to accumulation, though this is rarely clinically significant Solid tumours : Certain malignancies, particularly hepatocellular carcinoma and metastatic disease, may elevate B12 levels [3] Evidence suggests that unexplained markedly elevated B12 levels without supplementation may sometimes be associated with underlying disease

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Greenhalgh T, Knight M, A'Court C, et al

Most people notice an improvement in energy levels within 24-48 hours, though results may vary

+ Piglets: intramuscular injection of 1 ml per head, on the 3rd day of age