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Methylation issues are very common (up to 40% of patients) and many patients unknowingly supplement with cyanocobalamin which may increase serum levels but will not improve symptoms 5
After treatment initiation and dose increases, patients should be observed carefully for signs and symptoms of pancreatitis (including persistent severe abdominal pain, sometimes radiating to the back and which may or may not be accompanied by vomiting)
The blood level of methylmalonic acid increases when a person has B 12 deficiency
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