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Immediate medical attention is required if taste changes are accompanied by: Severe, persistent vomiting preventing adequate fluid intake Signs of dehydration (dark urine, dizziness, decreased urination) Severe abdominal pain, particularly if persistent or worsening Symptoms of pancreatitis (severe upper abdominal pain radiating to the back, nausea, vomiting) Right upper quadrant pain, fever, or yellowing of skin/eyes (possible gallbladder disease) Symptoms of hypoglycemia (if also taking insulin or sulfonylureas): shakiness, sweating, confusion, irritability These symptoms may indicate serious adverse effects requiring urgent evaluation, including pancreatitis, gallbladder disease, gastroparesis, or severe dehydration

Not all articles specify which form of B12 was used in the respective study

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3) presented a fragment at m/z 296.1315, corresponding to the loss of the oxime moiety (186 Da