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If we could access any liver stores of B12 wd would be well

That means: Hypokalemia can develop or worsen which can lead to: Cardiac arrhythmias Muscle weakness QT prolongation In severe cases, sudden cardiovascular instability This is a classic board-style pearl that many clinicians forget because B12 feels benign. But in profoundly deficient patientsespecially those with severe megaloblastic anemiarepletion is metabolically active treatment

If someone is insulin resistant, has sleep apnea risk, edema tendencies, or a cancer history, you dont treat this like a casual supplement decision