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Hold the needle steady for 5-10 seconds after the plunger is fully depressed to ensure the medication has distributed evenly and the pressure has equalized

People at highest risk include those with pernicious anaemia, strict vegans and vegetarians, individuals over 60, patients with gastrointestinal disorders (Crohn's disease, coeliac disease), those who have had gastric or bariatric surgery, and long-term users of metformin or proton pump inhibitors

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Finally renal damage may occur in hypovitaminosis A, with evidence of oedema in the inguinal and axillary regions secondary to failure of the renal tubular filtration system