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How well the treatment is working is checked by looking at blood counts and symptoms

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Factors contributing to this decline include: Increased activity of NAD+-consuming enzymes (like PARPs, which work overtime to repair accumulated DNA damage)

Hydroxocobalamin may also be given intravenously in certain scenarios (for example, 5 g IV for acute cyanide poisoning antidote therapy), but such high-dose use is in emergency settings and distinct from routine deficiency treatment

You have undergone weight loss surgery or have a medical condition that interferes with food absorption

Low levels often cause fatigue and weakness