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Question answered:21/02/08
The NLH Q&A Service receives questions relating to frequency of vitamin b12 injections more often than any other question. We have never found a trial comparing different timescales.
CKS in their guideline on macrocytic anaemia [1] mentions bypass surgery as a potential cause of vitamin b12 deficiency, but does not give specific advice regarding patients who have had that intervention. It later reports:
“Vitamin B12 replacement requires intramuscular injection, as the usual cause is malabsorption. Initial treatment if there is no neurological involvement is with six injections of hydroxocobalamin 1 mg at intervals of between 2–4 days, followed by 1 mg every 2–3 months for life. Initial treatment if there has been neurological involvement is with hydroxocobalamin 1 mg on alternate days until no further improvement, followed by 1 mg every 2 months for life.”
The British Society of Gastroenterology published “Guidelines for management of patients with a short bowel” in 2006 [2]. While this discusses vitamin b12 it doesn’t recommend a particular timeframe.
Given the absence of clear guidance we recommend you discuss this with a local specialist.
References
1) http://cks.library.nhs.uk/anaemia_macrocytic/view_whole_guidance
2) http://www.bsg.org.uk/pdf_word_docs/short_bowel.pdf
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