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Small amounts of foam are normal and will dissipate within a few minutes if you let the vial sit undisturbed

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Indications of vitamin deficiency may include Fatigue Bone pain Muscle weakness Muscle aches Muscle cramps Poor sleep Depression or feelings of sadness Hair loss Loss of appetite Increased susceptibility to illness You should undergo vitamin level testing and take appropriate measures if your levels are low

115 , 116 The guidelines for diagnosis and management of the cobalaminrelated remethylation disorders recommend treatment with parenteral hydroxylcobalamin in suspected cases of remethylation disorder, the incidence of serious complications, and for significant improvement in patient survival