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A patient with unexplained fatigue should be worked up, not injected masking a B12 deficiency of unclear cause, or an unexamined thyroid problem, with a monthly shot is a real clinical risk

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Patients experiencing neurological symptoms such as paresthesias, balance problems, or cognitive changes warrant prompt B12 assessment with same-day clinical evaluation for severe or rapidly progressive symptoms

Injections are typically subcutaneous in the abdomen, thigh, or upper arm

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