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B12 is contraindicated in Lebers Disease (a hereditary optic nerve atrophic condition), clients with chronic liver and/or kidney dysfunction, or abnormal red blood cells (megaloblastic anemia)

Typically, healthcare providers will assess a patient's vitamin B12 levels and symptoms before recommending a personalized treatment plan

However, rare point mutations in the TBX1 gene indicate that TBX1 haploinsufficiency is responsible for most of the physical abnormalities associated with 22q11.2DS, and they have also been associated with attention deficits, mild mental retardation, learning difficulties, developmental delay, Aspergers syndrome, and depression (2, 3, 4, 5)

[77] Non-ruminant, non-hindgut herbivores may have an enlarged forestomach and/or small intestine to provide a place for bacterial fermentation and B-vitamin production, including B 12