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Treatment typically requires intramuscular hydroxocobalamin injections (1 mg three times weekly initially, then every 23 months lifelong) when malabsorption or neurological symptoms are present

Check the powder color (should be blue to blue-purple), look for a third-party COA, verify HPLC testing, ensure the packaging is amber glass, and buy only from suppliers that disclose concentration and batch numbers

This may be associated with a high fever and joint pains (Erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis) Muscle weakness

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