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Injections are indicated when there's confirmed severe deficiency, pernicious anemia (an autoimmune condition where intrinsic factor is absent), or documented malabsorption that prevents oral B12 from reaching adequate levels

We occasionally see this mistaken for a normal study (a negative result) when strict timing cutoffs are applied without consideration of the transit effects

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Laboratory results revealed acidosis with a pH of 7.34, elevated anion gap, beta-hydroxybutyrate, severe hypokalemia, hypophosphatemia, and acute kidney injury