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V., Deshmukh, A

Check valve prevents water from reversing and flowing back down into the sump

The gas chemically inactivates B12 through irreversible oxidation of its coenzyme form, methylcobalamin, at the active site of the B12dependent methionine synthase reaction

Additional risk factors include: Chronic kidney disease : Reduced renal clearance may impair B12 excretion Liver disease : Hepatic dysfunction can disrupt B12 metabolism and storage Myeloproliferative disorders : Certain blood cancers increase B12-binding proteins Concurrent medication use : Some drugs may interact with B12 metabolism, including metformin, proton pump inhibitors, and H2 antagonists Patients with these conditions should have B12 supplementation carefully monitored by their healthcare team

Sources Food sources Only certain bacteria and archaea can synthesize vitamin B 12 (123, 124)