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However, monitoring serum MMA concentrations alone or in combination with serum cobalamin concentrations might be a more appropriate way to reevaluate the canine cobalamin status after treatment.59 A study investigating the effect of injectable hydroxocobalamin for the treatment of Beagle dogs with IGS showed a dose of 1 mg hydroxocobalamin administered IM to be adequate for maintaining a normal clinical status and normal urine MMA concentrations for up to 2 months.59 Hydroxocobalamin is considered the treatment of choice for children with IGS88, 133, 134 and other types of hereditary cobalamin deficiency.135, 136 It is likely more effective than cyanocobalamin because this compound presents the natural form of cobalamin.137 In addition, IM injections of hydroxocobalamin appear to cause less pain than cyanocobalamin.134 5.2