severe diarrhea after b12 injection Pernicious Anemia: Definition, Symptoms, Causes & Treatment B12 Shots: Vitamin B12 Injections

Normal vital signs (blood pressure, heart rate, respiratory rate, temperature) and body mass index (BMI) between 18 and 30 kg/m 2 Suboptimal vitamin B12 status (deficient to borderline 200300 pg/mL), defined as serum B12 levels within the lower end of the reference range (234894 pg/mL) Able to provide informed written consent Able to comply with study procedures and follow-up visits as outlined in the protocol 2.2.2 Exclusion criteria Known hypersensitivity or allergy to oral vitamin B12 supplements or any of its components Known history of cobalt allergy or sensitivity Severe malabsorption syndromes, including pernicious anemia or intestinal disorders affecting vitamin B12 absorption Current use of acetaminophen, nonsteroidal anti-inflammatory drugs, antibiotics, antacids, proton pump inhibitors (PPIs), multivitamins, or nutritional supplements containing vitamin B12 History of gastric bypass surgery or other procedures that significantly alter GI anatomy or function Significant renal impairment (estimated glomerular filtration rate [eGFR] 0.05) Supplementary Table 1

Patients require lifelong hydroxocobalamin injections, typically 1mg every three months following an initial loading regimen (or every two months if there was neurological involvement)

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Biochemical changes showing early deficiency 3

When our bodies fat cells grow larger as we gain weight, it causes excess production of NNMT (Nicotinamide N-methyltransferase), a cytosolic enzyme that works to slow down fat cell metabolism

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