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Surg Obes Relat Dis

Pemetrexed-based chemotherapies are recommended for MPM [3]

Neurological symptoms represent a significant concern with B12 deficiency and may include: Paraesthesia (pins and needles) in the hands and feet Difficulty with balance and coordination Memory problems or cognitive changes Mood disturbances , including depression or irritability Glossitis (sore, red tongue) and mouth ulcers Haematological manifestations of B12 deficiency include megaloblastic anaemia , characterised by the production of abnormally large, immature red blood cells

The advice is to investigate and treat the vitamin B12 deficiency in the normal way, following clinical guidelines, and to continue the metformin