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After much bloodwork they can find no explanation

And finally, monitoring potassium is more relevant in patients with any pre-existing renal or cardiac disease, or other risk factors rather than universally in all patients receiving methylcobalamin

How do you think that this rule could be verified

Context matters: Smoking status, alcohol intake, genetic polymorphisms (e.g., MTHFR for folate), and baseline inflammatory burden can flip a vitamins effect from protective to neutralor even harmful