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Water retention: Slight puffiness in the hands or feet, most common during the escalation phase and typically self-limiting

Many of the symptoms caused by low B12 levels are not specific to B12 deficiency, which can cause the condition to go undetected

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Treatment must therefore be based on the real mechanism, not only on the diagnosis name

High-dose vitamin B12 supplements taken concurrently with the injection may lead to excessive B12 levels, though toxicity from vitamin B12 excess is extremely rare due to its water-soluble nature and efficient renal excretion