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If needed for a clear medical indication (such as treating pellagra in a pregnant patient), niacinamide can be used with caution, but unnecessary high-dose B supplementation is avoided in pregnancy

Once administered intramuscularlytypically into the deltoid or gluteal musclehydroxocobalamin (the form most commonly used in the UK) enters the bloodstream rapidly

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283 Acute liver failuresevere liver injury, including international normalized ratio greater than 1.5 and hepatic encephalopathy, developing within 26 weeks after onset of symptoms without evidence of preexisting liver disease Presentation The presenting symptoms of patients with acute liver failure are usually those of acute hepatitis, including malaise, nausea, and jaundice

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