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During the initial treatment period with methylcobalamin, pulmonary edema and congestive heart failure have reportedly occurred early in treatment with parenteral methylcobalamin

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Factors known to affect caking kinetics may be divided into intrinsic properties of the powder itself (water activity, particle size distribution, presence of impurities, and glass transition temperature) and external factors such as temperature, relative humidity and mechanical stress applied to the substance [13]

In many patients, those factors are the reason recovery feels slow in the first place

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