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The third phase is that of metabolic alterations, in which the levels of waste products such as methylmalonic acid increase in the blood

Vitamins | Treatment summaries | BNF NICE

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These include: Age and overall health status Severity of Vitamin B12 deficiency Presence of underlying medical conditions, such as gastrointestinal disorders Concurrent medications that may interact with Vitamin B12 For example, older adults or those with severe deficiencies might need more