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NHS approach to B12 deficiency: NICE Clinical Knowledge Summaries recommend investigating B12 deficiency in patients presenting with macrocytic anaemia, unexplained neurological symptoms, or risk factors including pernicious anaemia, gastrectomy, malabsorption disorders, metformin use, proton pump inhibitors, or nitrous oxide exposure

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you'll feel a quick pinch and that's it

indeed, people with very low blood pressure or those prone to orthostatic hypotension should not use niacinamide injections without careful monitoring