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Intramuscular hydroxocobalamin injections represent the standard treatment for most cases: Initial loading regimen : For patients with neurological symptoms, 1 mg on alternate days until no further improvement occurs (typically 23 weeks)

This method bypasses the digestive system, ensuring maximum absorption and effectiveness

Rapid intravenous injection may result in cardiac arrhythmias and in severely toxic cows, collapse and death

The NIH Office of Dietary Supplements identifies post-bariatric surgery patients as a group requiring monitoring and potentially injectable supplementation

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