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Recheck at 4 to 6 weeks, escalate to IM if not rising adequately

doi: 10.1016/s0950-3536(05)80216-1 67 BottiglieriTHylandKReynoldsEH

Many, but not all of these cases, have shown a positive response to treatment with vitamin B12, based on improvements in abnormal metabolite levels and clinical indices (Stabler et al., 1990)