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Even a few hours above 8 degrees Celsius accelerates degradation significantly

The 4 stages of B12 deficiency include (31): Stage 1: decreased levels of vitamin B12 in your blood Stage 2: low levels of vitamin B12 in your cells along with metabolic abnormalities Stage 3: neurological and psychological symptoms like anxiety, confusion, problems with balance, and others Stage 4: macrocytic anemia very large red blood cells (32) B12 deficiency can cause a variety of symptoms, including fatigue, headaches, depression, pale or yellow skin, mental impairment, and pain and inflammation in the mouth and tongue

Theodoridis X, Grammatikopoulou MG, Stamouli EM, et al

Each tube should be labeled clearly with either A' for the sucrose solution or B' for pure water, or alternatively, the initial weight of the bottles can be recorded

We recommend that you dose up if your symptoms are extreme which would indicate a severe deficiency