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Any noticeable change during room-temperature storage warrants extra scrutiny

Root cause analysis

Serum studies should include a complete blood count and serum electrolytes, including calcium and magnesium
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The most common cause id due to a condition called pernicious anaemia

Recommended B12 doses for adults 55+: Sublingual (under tongue): 1,000-2,500 mcg daily Oral tablet: 1,000-2,000 mcg daily B12 injection: 1,000 mcg monthly (by prescription) Which Form of B12 is Best
