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That means: Hypokalemia can develop or worsen which can lead to: Cardiac arrhythmias Muscle weakness QT prolongation In severe cases, sudden cardiovascular instability This is a classic board-style pearl that many clinicians forget because B12 feels benign. But in profoundly deficient patientsespecially those with severe megaloblastic anemiarepletion is metabolically active treatment

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For example, antacids containing aluminum or magnesium (often used for heartburn) can interfere with how much azithromycin is absorbed

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