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Diagnosis usually entails measuring serum levels of vitamin B12 or identifying elevated levels of methylmalonic acid and homocysteine

The right next step depends on the reader's evidence, safety, cost, access, and provider-review needs

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The initial management of overdose: After a careful clinical evaluation of the patient the importance of time elapsed since last ingestion or administration, the amount of poison swallowed and discarding the contraindication of certain procedures, the professional will decide whether or not the treatment of general rescue: emesis or gastric lavage, activated charcoal and saline purgative (45 to 60 minutes after the activated carbon), hemodialysis