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Elevated serum B12 levels may sometimes indicate underlying medical conditions rather than true overdose, warranting clinical investigation to exclude haematological disorders, liver disease, or renal impairment

doi: 10.1038/s41467-021-24132-6 60 KiebikASzlasaWNovickijVSzewczykAMaciejewskaMSaczkoJet al

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They may also have subclinical conditions that could be affected by metabolic changes