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For this reason, even those who consume sufficient amounts of vitamin B12 in their diets could still have a functional B12 deficiency

Vitamin B12 can come in various forms, but all of them have a mineral called cobalt in them

6 However, most deficient patients did not have hematologic manifestations, and neurologic manifestations were not assessed

The cobalt deficiency was overcome by the development of "cobalt bullets", dense pellets of cobalt oxide mixed with clay given orally, which then was retained in the animal's rumen

Vitamin B12 There is four types of parenteral Vitamin B12 available: Cyanocobalamin 100 mcg/ml and 1000 mcg/ml best used as IM to prevent rapid loss via kidneys Hydroxycobalamin IM (compounded 1000 mcg/ml or more) known as long acting B12 (binds better to plasma proteins than cyanocobalamin) Methylcobalamin IV (compounded 1000 mcg or more up to 5000 mcg/ml) Adenosylcobalamin IV Common dose is 1000 mcg IM or IV Vitamin B12 as hydroxycobalamin is synthesized exclusively by microorganisms and is found in the liver of animals bound to protein as methylcobalamin = metabolically active form of Vitamin B12 Hydroxycobalamin is a chelator of cyanide and is used in cyanide poisoning Hydroxocobalamin is most generally used for vitamin B12 replacement therapy and is considered the drug of choice for vitamin B12 deficiency by the Martindale Extra Pharmacopoeia (Sweetman, 2002) and the World Health Organization (WHO) Model List of Essential Drugs