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These timing thresholds were developed according to evidence-based clinical guidelines, including those developed by The Joint Commission, American College of Emergency Physicians, and the Emergency Department Benchmarking Alliance, [310 311] as well as from input from a TEP, literature reviews, and environmental scans

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Approximately one year later, he experienced a severe worsening of his previously very mild neuropathy, and lab evaluation yielded a serum B12 of 220 pmol/l (which is normal, remember!?), but an elevated serum MMA of 1300 nmol/l, supporting the existence of true B12 deficiency