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Normalization of hematological abnormalities can take up to 14 days.74, 87 Urinary MMA excretion as well as the serum MMA concentration can be expected to normalize (ie, decrease to within RI) within a week of initiating cobalamin supplementation.17, 74, 87 However, proteinuria in dogs with selective cobalamin malabsorption will persist lifelong due to abnormal renal tubular cubam function that is not corrected by cobalamin supplementation.131 In people with IGS, tubular proteinuria does not adversely affect renal function, and long‐term follow‐up of affected human patients (up to 50 years) suggests that renal prognosis is excellent.132 Dogs with selective cobalamin malabsorption—if left untreated—will die as a result of metabolic derangements and immunodeficiency.78, 81, 83, 92 There is limited evidence‐based information about the optimum route, dose, and dosing interval of cobalamin supplementation in dogs available
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