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However, the levels of cyanide resulting from cyanocobalamin are so minimal that the term toxic is hardly applicable here Build up in the cells: studies have shown that around 1000 g of cyanocobalamin accumulates in the cell fluid during therapy with high dosages (2)

Using an unnecessary acidic solution can alter the pH and potentially impact the stability of the peptide structure over time

When the body takes in insufficient fluid or loses excess amounts of fluid through sweating or illness, the urines concentration increases, and the yellow colour darkens

Rescue therapy was needed by 8%, 25%, and 67%, respectively. Five milligrams preserved most, but not all, of the benefit of continuing the effective dose