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You should seek prompt medical attention if you experience: Symptoms of advanced liver disease , including jaundice (yellowing of skin or eyes), persistent abdominal swelling, confusion or altered mental state, easy bruising or bleeding, or dark urine with pale stools Unexplained symptoms such as severe fatigue, unintentional weight loss, persistent nausea, or abdominal pain, particularly in the right upper quadrant Signs of complications , including vomiting blood, black tarry stools, or swelling in the legs and ankles Your healthcare provider will likely arrange further investigations to clarify the cause of elevated B12 and assess liver function
