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If the sPESI is greater than or equal to 1 and there are any symptoms of hemodynamic instability, including systolic blood pressure less than 90 mmHg, mean arterial pressure less than 65 mmHg, a drop in systolic blood pressure of 40 mmHg that persists for greater than 15 minutes, or evidence of end organ hypoperfusion, the in-hospital mortality risk is considered high

Mood disturbances, including depression and irritability, are also recognised manifestations of B12 deficiency

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Some medications may also cause a metallic taste, such as particular types of antibiotics, antihistamines, and antidepressants