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Common causes include: Pernicious anaemia Malabsorption disorders (e.g., coeliac disease, Crohns) Chronic alcohol abuse Long-term use of antacids or metformin Vegan or vegetarian diet without supplementation 3
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The trade-off is that lower concentrations deplete the vial faster across multiple doses
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For ongoing care: 1 mL (1000 mcg) given as an intramuscular shot once a month
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