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Hydration, nutrition, sleep, stress levels, and medical care all influence hair, skin, nails, energy, and metabolism

[5] This is an emerging area of interest, particularly for patients dealing with both excess weight and degenerative joint disease

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Essential supplies include: Hydroxocobalamin ampoules (typically 1mg in 1ml) Sterile syringes (usually 2ml or 3ml) Drawing-up needles (typically 21G for withdrawing from ampoule) Injection needles (23G-25G for subcutaneous

Dosing information Usual Adult Dose for Pernicious Anemia: Initial dose: 100 mcg intramuscularly or deep subcutaneous once a day for 6 to 7 days If clinical improvement and reticulocyte response is seen from the above dosing: 100 mcg every other day for 7 doses, then: 100 mcg every 3 to 4 days for 2 to 3 weeks, then: Maintenance dose: 100 to 1000 mcg monthly Duration of therapy: Life Comments: Administer concomitant folic acid if needed

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