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Because it is essentially water without sufficient solute, direct intravenous administration can cause red blood cell lysis (hemolysis) due to its hypotonic nature

Subsequently, German internist Arnold Cahn (1858-1927) and German physician and physiologist Josef Freiher von Mering (1849-1908), working in the Strassburg clinic of German physician Adolf Kubmaul (1822-1902), showed that a patient with pernicious anemia had no hydrochloric acid in the stomach contents, a finding later demonstrated to be pervasive in this disorder and to precede the development of anemia (139)

The label also warns that it contains benzyl alcohol and aluminum, and that serious reactions, including allergic reactions, have been reported with parenteral vitamin B12

Clinical and anatomical studies