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This dinucleotide structure, with the chemical formula CHNOP and molecular weight of 663.43 daltons, enables NAD+ to function as a versatile electron carrier and signaling molecule that participates in hundreds of enzymatic reactions throughout cellular metabolism

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Patients should be reviewed 812 weeks after commencing treatment to assess: Symptomatic improvement, particularly resolution of fatigue and neurological symptoms Haematological response (normalisation of haemoglobin and mean cell volume) Reticulocyte count typically rises within one week, indicating bone marrow response Repeat serum B12 testing is generally not useful after starting parenteral therapy, as levels remain elevated for months

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