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It can take up to 5 years before a deficiency manifests itself clinically, and NPs should be aware and alert to the possibility of B12 deficiency in their patients on prolonged metformin

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For example, for brain injury associated with increased intracranial pressure, osmotic agents such as mannitol or active pharmaceutical ingredients (APIs) to decrease fluid around the brain may be administered along with other medications potentially including analgesics or anticonvulsants.3 Despite these treatment options, the Agency for Healthcare Research and Quality still reports longer stays and increased hospital mortality for patients diagnosed with TBI compared with other inpatient stays.4 Given the frequency and severity of brain injury in general and TBI specifically, development of new effective therapeutic options is crucial to reducing morbidity and mortality in patients suffering from brain injury