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[41] : 975 Children diagnosed with low serum B 12 can be treated with intramuscular injections, then transitioned to an oral dietary supplement

When stratified by administration route, the average percentage reductions were: Intramuscular (IM): 48.3% Sublingual: 30.7% Oral: 30.3% These results suggest that IM administration leads the most pronounced homocysteine reduction, however, sublingual and oral routes also demonstrate clinically relevant effects

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[55] If nervous system damage is present and blood testing is inconclusive, a lumbar puncture may be carried out to measure cerebrospinal fluid B 12 levels