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difficulty breathing

However, this is a very broad generalization

Sublingual tablets or sprays : Designed to dissolve under the tongue, though evidence of superior efficacy over standard oral forms is limited

Akbarian, M., et al

Sequential resonance assignments as a basis for determination of spatial protein structures by high resolution proton nuclear magnetic resonance

Interpretation should consider: Symptoms CBC (especially if basophilia, leukocytosis, etc.) Liver function tests Renal function Inflammatory markers Even high serum cobalamin levels can be accompanied by functional deficiency Suggested Workup for Unexplained High B12 : Repeat B12 measurement off supplements Check: Liver enzymes CBC with differential Serum creatinine Holotranscobalamin active fraction of vitamin B12, bound to TCB II 8 Consideration of myeloproliferative neoplasm workup if hematologic abnormalities are present Imaging if malignancy suspected (e.g., abdominal imaging if liver pathology or malignancy is suspected) In summary, while elevated B12 is most often benign and related to supplementation or liver/renal dysfunction, it is essential to rule out underlying hematologic malignancy or solid organ cancer when unexplained or accompanied by abnormal clinical or laboratory findings