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Kidney Dysfunction: While the kidneys do not directly excrete vitamin B12 efficiently, impaired renal function may lead to elevated serum B12 levels by reducing the clearance of B12-binding proteins or altering their metabolism, thereby contributing to B12 accumulation 8

Refrigerate after mixing, especially when asking: does reconstitution fluid need to be refrigerated

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Some of them are as follows: Small intestine bacterial overgrowth (SIBO): The harmful bacteria use the available B12 before it has been absorbed by the small intestine, thereby leading to a deficiency

M ace-r = 89.67, p = .017 respectively)