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However, when immune system exhausts and/or compromised, the viral infection become aggressive in vulnerable hosts and evolves into a severe pathophysiological state with hyper-inflammation, extensive tissue damage, and MODS 682

Discontinuation is appropriate if palpitations are accompanied by syncope, sustained irregular rhythms documented on ECG, or evidence of cardiac ischemia

Certain groups face elevated risk of B12 deficiency and should discuss testing with their healthcare provider: Individuals following vegan or strict vegetarian diets without adequate supplementation Older adults (particularly those over 60 years), due to reduced gastric acid production People with gastrointestinal conditions including Crohn's disease, coeliac disease, or those who have undergone gastric or ileal surgery Long-term users of medications affecting B12 absorption, such as metformin (MHRA advises monitoring B12 levels), PPIs, or H2-receptor antagonists Individuals with pernicious anaemia or family history of this autoimmune condition People with exposure to nitrous oxide (recreational or occupational), which can cause functional B12 deficiency Diagnostic testing typically involves serum B12 measurement , though this may not always reflect tissue stores accurately