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77 In contrast, the pathology of HAPE is best understood among high-altitude illnesses for well-conducted autopsy studies

Neurologic, cognitive, hematologic, or mucosal features can point to a shortfall, as can risk factors such as malabsorption, autoimmune gastritis, relevant medications, or nitrous oxide exposure

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Maintenance doses are typically 1 mg every 2-3 months for life High-dose oral therapy (1000-2000 micrograms daily) may be effective in selected patients with pernicious anaemia under clinical supervision, as passive diffusion can compensate for absent intrinsic factor, though this is not routine first-line treatment in the UK The water-soluble nature of B12 means that high-dose supplementation carries minimal risk of toxicity , making it a safe option for individuals with confirmed or suspected deficiency