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The most frequent symptoms are: Developmental delays Anaemia Loss of appetite Chronic vomiting Weight loss Low brain volume Spasms/cramps Apathy Irritability In the most severe instance, vitamin B12 deficiency can lead to respiratory failures and coma (51)

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Causes of Inadequate Responsiveness to Therapy Pseudoresistance White-coat hypertension or office elevations Pseudohypertension in older patients Use of regular adult cuff on a very obese arm Nonadherence to therapy Volume overload Excess salt intake Progressive renal damage (nephrosclerosis) Fluid retention from reduction of blood pressure Inadequate diuretic therapy Drug-related causes Doses too low Wrong type of diuretic Inappropriate combinations Rapid inactivation (e.g., hydralazine) Drug actions and interactions Sympathomimetics Nasal decongestants Appetite suppressants Cocaine and other illicit drugs Caffeine Oral contraceptives Adrenal steroids Licorice (as may be found in chewing tobacco) Cyclosporine or tacrolimus Erythropoietin Antidepressants Nonsteroidal anti-inflammatory drugs Associated conditions Smoking Increasing obesity Sleep apnea Insulin resistance or hyperinsulinemia Ethanol intake of more than 1 oz (30 mL) per day Anxiety-induced hyperventilation or panic attacks Chronic pain Intense vasoconstriction (arteritis) Organic brain syndrome (e.g., memory deficit) Identifiable causes of hypertension Adapted from JNC-7 Express, National Heart, Lung, and Blood Institute

Vitamin B12 is critical for metabolism because it helps the body turn food into energy that it can use