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* Administer naloxone, if available

When B12 levels are insufficient, the bone marrow produces fewer but larger red blood cells a pattern known as megaloblastic anaemia
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2004, Ed Masson, Barcelona Hvas AM, Juul S, Nexo E, Ellegaard J: Vitamin B-12 treatment has limited effect on health-related quality of life among individuals with elevated plasma methylmalonic acid: a randomized placebo-controlled study
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Phase 2 trial (NEJM 2023) reported 24.2% mean weight loss at 48 weeks with 12 mg/week retatrutide, with gastrointestinal adverse events rising sharply at the 8 mg and 12 mg doses
