Children presenting neurological signs or symptoms, those unable to take oral medication, individuals with known malabsorption syndromes, infants under 6 months old, and patients using medications that may interfere with vitamin B12 absorption are typically treated with a parenteral protocol (1)
dryness or tightness of the throat
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Mechanistically, choline and methionine relate to hepatic fat transport and one-carbon metabolism
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Serum Vitamin B12 levels and methylmalonic acid (MMA) tests help confirm the deficiency