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UK guidelines recommend monitoring clinical response and full blood count (typically at around 2 months) to ensure treatment adequacy, rather than routinely rechecking B12 levels after replacement has started

Vitamin B12 is essential for sustaining healthy red blood cells and nerve cells and converting food into energy

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This model proposes that mGSH depletion due to its covalent binding to NAPQI acts as a first-hit, which is followed by a burst of mitochondrial ROS production that activates a second hit involving mitogen-activated protein kinases (MAPKs) that in turn amplifies the wave of mitochondrial ROS generation (Lemasters, 1998)