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Giving folic acid alone to someone with undiagnosed B12 deficiency can precipitate or worsen neurological damage

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The first group considered at high risk for severe B12 deficiency had serum B12 287pmol/L and a median methylmalonic acid concentration of 120nmol/L, while the third group was classified as indeterminate and difficult to interpret with an intermediate serum B12 (126287pmol/L)

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Additionally, certain medicationslike proton pump inhibitors (PPIs) and metformincan affect B12 absorption if not spaced out appropriately