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Other indicators include a family history of pernicious anaemia or other autoimmune conditions (such as type 1 diabetes mellitus, Hashimotos thyroiditis, or Graves disease), or if the patient is taking metformin, proton pump inhibitors (PPIs), H2 antagonists or has a history of nitrous oxide misuse[15]

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[6] [25] At levels only slightly below normal, deficiency can result in fatigue, headaches, feeling faint, rapid breathing, pale skin, numbness or tingling, poor appetite, heartburn, poor balance, difficulty walking, poor reflexes, blurred vision, memory problems, depression, irritability, inattention, cognitive decline, dementia, and even psychosis

Why the kidneys are affected The kidney issue is not random