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One important consideration: a 5mg vial reconstituted with 2mL of water gives you excellent measurement precision at the 1mg dose level (40 units, very easy to read), but the 4mg dose would require 160 units, far exceeding the syringe

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The diagnosis is supported by characteristic findings, including macrocytic anemia, low serum vitamin B12 levels, and abnormal results on gastroscopy or spinal MRI [5]