A nosebleed, meaning a loss of blood from the tissue that lines the inside of your nose, can occur in one or both nostrils. Sometimes, though, it can be hard to judge how much blood you've lost. a bloody nose can be an emergency. When is a nosebleed a cause for concern? This will allow your doctor to see if the medicine is working properly. If you are using this medicine to treat vitamin B12 deficiency caused by pernicious anemia, you will need to use the medicine for the rest of your life. 2023 Healthline Media UK Ltd, Brighton, UK. Nosebleeds are a common occurrence that typically do not require emergency medical attention. Some think taking megadoses is best for their health. As non-vegetarianstend to have higher levels. This is a common occurrence and rarely a cause for concern. Hot, low humidity climates can cause dry air. https://www.mayoclinic.org/drugs-supplements/cyanocobalamin-intramuscular-route/side-effects/drg-20137833, Advertising and sponsorship opportunities. Peripheral nerve damage may lead to tingling in these parts of the body. 1996-2023 Everyday Health, Inc., a Ziff Davis company. A bloody nose usually stops after a few minutes and is nothing serious. The ideal dose of vitamin B12 varies based on your sex, age, and reasons for taking it. Major incidents like falling down stairs, sports accidents, and fights can cause a bloody nose that becomes a medical emergency. Last medically reviewed on February 28, 2022. MedlinePlus. (2018, November 29). These vessels help warm and moisten the air you breathe. Anticoagulants are blood-thinning medications, such as aspirin. This may increase their risk of side effects (4). Food companies sometimes add nutrients to foods during the manufacturing process. Kristin Hayes, RN, is a registered nurse specializing in ear, nose, and throat disorders for both adults and children. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. Cyanocobalamin cyanocobalamin injection. We avoid using tertiary references. Risk factors for vitamin B12 deficiencyanemia include: Each persons symptoms may vary. New masking guidelines are in effect starting April 24. Below, we look at the symptoms of vitamin B-12 deficiency and their causes. No information is available on the relationship of age to the effects of cyanocobalamin injection in geriatric patients. When you are anemic, you don't have enough red blood cells. Megaloblastic anemia due to vitamin B-12 deficiency may lead to a person feeling fatigued. Do not swallow a lozenge or sublingual tablet whole. This reduces blood pressure and slows further bleeding. Vitamin B12 is not as well absorbed by mouth as per injection. Getting too much of these nutrients may increase the risk of lung cancer (1, 4, 11). Current approaches to epistaxis treatment in primary and secondary care. A few tablespoons can look like a lot. However, folic acid will not treat Vitamin B12 deficiency and will not prevent possible damage to the spinal cord. If you are on blood-thinning medications, you should also seek medical help. Before your visit, write down questions you want answered. You also have the option to opt-out of these cookies. Yes, this is the right drop. Its important to note that theres no DRI available for folic acid, the synthetic form of vitamin B9 that you can find in multivitamins. Ask a doctor or pharmacist if this medicine is safe to use if you have ever had: Ask a doctor before using this medicine if you are pregnant or breastfeeding. . Cognitive impairment and vitamin B12: A review [Abstract]. Although there are many reasons that your nose bleeds, the two most common causes are direct impact injury and the temperature and humidity of your environment. However, some manufacturers opt to get their supplements verified by third-party labs, which can confirm whether theyre free of contaminants and that they truly contain what the label states. Long-term antacid use linked to vitamin B12 deficiency, Vitamin B12 benefits, food sources, deficiency symptoms, and more, glossitis, which causes a swollen, smooth, red tongue, being older, because a person becomes less able to absorb B-12 as they age, taking anti-acid medication for an extended period, weight loss surgery or other stomach surgery, which can affect how the digestive system absorbs vitamin B-12. The dangers of vitamin B12 deficiency lie mainly in the damage it causes to the nerve endings. These cookies ensure basic functionalities and security features of the website, anonymously. Heavy, nonstop, or frequent bleeding is cause for concern. Symptoms include weak muscles, numbness, trouble walking, nausea, weight loss, irritability, fatigue, and increased heart rate. Know what to expect if you do not take the medicine or have the test or procedure. This may seem difficult. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, Nicole Leigh Aaronson, MD, MBA, CPE, FACS, FAAP, https://pubmed.ncbi.nlm.nih.gov/30273433/, https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC6060781/, https://www.nhs.uk/conditions/chemotherapy/side-effects/, https://cks.nice.org.uk/topics/epistaxis-nosebleeds/background-information/causes/, https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC5782932/, https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC6937692/, https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC6047638/, https://www.ncbi.nlm.nih.gov/books/NBK435997/, https://www.sciencedirect.com/science/article/pii/S016558761830377X, One-hour endoscopic procedure could eliminate the need for insulin for type 2 diabetes, New clues to slow aging? Vitamin B-12 is safe to take in recommended dosages if youre pregnant or breastfeeding. Minimizing irritation to the nasal lining, avoiding activities that may result in facial injury, and keeping the inside of the nose moist can all help prevent nosebleeds. For those who cannot, a doctor may prescribe or recommend B-12 supplements. Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features. Consult a doctor now! 9 Best Orthotics For Standing On Concrete. UK, Nosebleeds are common because of the position of the nose and its high density of blood vessels. She is taking Telma 40, twice a day. Folic acid, also called folate, is another B vitamin. You may need frequent medical tests to help your doctor determine how long to treat you with cyanocobalamin. At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. The sections below highlight the nutrients from each category that may be particularly harmful if you take them at high doses. These cookies track visitors across websites and collect information to provide customized ads. Despite this, multivitamins are not risk-free. It's no secret that vitamins can improve your health, but not all vitamins and minerals are created equal. Nutrient levels in some multivitamins may sometimes even reach or exceed the daily UL. Local trauma is the most common cause of nosebleeds. The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional". How is Hynasal 15 ml, Sodium chloride saline nasal drops? A bloody nose that is caused by high blood pressure is an emergency. Smokers and former smokers may especially benefit from avoiding multivitamins containing high amounts of vitamin A or beta carotene, which the body can convert into vitamin A. These often occur due to: Yes. If yes, it could be the cause. Nosebleed. easy bruising or bleeding (nosebleeds, bleeding gums); extreme tiredness; . Continue putting pressure on the nose, leaning forward, and sitting upright for 1015 minutes so that the blood clots. Depending on the nutrient and its dosage, some side effects may occur very quickly, while others may take a longer time to develop (11). This article reviews whether a vitamin B12. Tell your healthcare provider about any symptoms and follow your treatment plan. A decreased appetite can lead to weight loss in the long term. However. Vitamin B12 plays many crucial roles in the body. Vitamin B12 medicine can be prescribed by your provider for you to take by mouth or as a nose spray or a shot. Dont take vitamin B-12 supplements if you have sensitivities or allergies to vitamin B-12, cobalt, and any other ingredients. (2018). Here are nine signs and symptoms of vitamin B12 deficiency. Can diet help improve depression symptoms? In posterior nosebleeds, the bleeding originates farther back and higher up the nose. Allergy to cobaltShould not be used in patients with this condition. coughing that sometimes produces a pink frothy sputum, difficult, fast, noisy breathing, sometimes with wheezing, puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue, swelling of the face, fingers, feet, or lower legs. Blood loss is most concerning if you have a history of blood diseases such as hemophilia or anemia. Living with vitamin B12 deficiency anemia. Complete hemogram report is already there in the reports you attached (attachment removed to protect patient identity). Some side effects are more common than others (2, 3). low levels of calcium or potassium in your blood; a bleeding or blood clotting disorder such as hemophilia; any condition that makes it hard for your body to absorb nutrients from food (malabsorption). (2018). How Quickly Do You See Results From Collagen? This article reviews the health. Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. India, bleeding from the gums or nose blue lips and fingernails chest pain cough coughing that sometimes produces a pink frothy sputum decreased urine output difficult, fast, noisy breathing, sometimes with wheezing difficulty with swallowing dilated neck veins dizziness extreme fatigue eye pain fast heartbeat headache hives, itching, or skin rash He completed his education at prestigious institutes like My mother is 68 years old, and two of her recent consecutive blood reports show very high vitamin B12 levels, over 1500. These may appear spontaneously but often result from unseen factors. Hatipoglu, H., Hatipoglu, M. G., Cagirankaya, L. B., & Caglayan, F. (2012, January). Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. Patients with a certain type of AML called acute promyelocytic leukemia (APL) might have problems with bleeding and blood clotting. A vitamin B12 deficiency can cause symptoms such as tiredness, weakness, constipation, weight loss, loss of appetite . There is a need for more research into the link between vitamin B-12 and mental health. 2. However, you may visit "Cookie Settings" to provide a controlled consent. Megaloblastic anemia, severeMay increase risk for hypokalemia. Severe periodontal destruction in a patient with advanced anemia: A case report. But it will let you live a normal life without symptoms. After the bleedinghas stopped, maintain her onNasoclear (, Tablet Pause (Tranexamic acid) can be given up to three times a day. Whats the correct dosage of vitamin B-12? These symptoms occur because vitamin B-12 deficiency causes a reduction in red blood cell . As vitamin B-12 deficiency shares many symptoms with other nutritional deficiencies and health conditions, it is possible that people may neither notice it nor get a diagnosis. Vitamin B12 deficiencyanemia is more common in people whose families come from northern Europe. Hope this helps you, and get back if you have any doubts. Immune thrombocytopenia, an autoimmune condition characterized by reduced platelets, Hereditary hemorrhagic telangiectasia, a rare genetic condition, Certain cancers such as leukemia, lymphoma, or nasal and sinus cancer. Injectable vitamin B-12, which is used to treat significant deficiencies, can cause the following side effects: Vitamin B-12 can cause very rare but serious allergic reactions (anaphylaxis). Increasing the amount of nicotinamide can cause a variety of health problems, including increased bleeding. These include: The main symptom of a nosebleed is blood coming from the nose. A well-balanced diet is the best way to obtain these nutrients. Red blood cells circulating under the skin provide it with its normal color. . .. your knowledge and teaches you hypertension facts .. Read full, Why is Aspirin given for high hemoglobin and RBC count? These may appear spontaneously but . This means theres a risk that a multivitamin could contain higher levels of nutrients than its label states. Oral vitamin B-12 is safe to take at recommended doses for healthy people. Vitamin B12 deficiency anemia is a condition in which your body does not have enough healthy red blood cells, due to a lack (deficiency) of vitamin B12. Thank you so much. Over time, peripheral nerve damage resulting from vitamin B-12 deficiency can lead to movement problems. This article discusses the cases in which you should make an appointment with a healthcare provider or go the hospital for a nosebleed. Call your doctor for medical advice about side effects. She was advised by thedoctor to take tablet Pause, which I am starting along with the Xylometazoline nasal drops. Avoid taking supplements if possible, and try to get B-12 from food sources. Current approaches to epistaxis treatment in primary and secondary care. Spotting the signs of vitamin B-12 deficiency early on and getting the right treatment can improve a persons outlook. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, What to know about vitamin B-12 deficiency, vegetarian and vegan sources of vitamin B-12, https://www.ncbi.nlm.nih.gov/pubmed/28189172, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3252802/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4884371/, https://e-cnr.org/DOIx.php?id=10.7762/cnr.2016.5.3.143, https://www.ncbi.nlm.nih.gov/pubmed/22221769, https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Peripheral-Neuropathy-Fact-Sheet, https://www.nhlbi.nih.gov/health-topics/pernicious-anemia, https://bestpractice.bmj.com/topics/en-us/822, https://ods.od.nih.gov/pdf/factsheets/Vitaminb12-Consumer.pdf, https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/, https://www.ncbi.nlm.nih.gov/pubmed/23782218/%20, One-hour endoscopic procedure could eliminate the need for insulin for type 2 diabetes, New clues to slow aging? This medicine is given as a shot into a muscle. One theory is that vitamin B-12 helps break down a brain chemical called homocysteine. A nosebleed is blood loss from the tissue inside a persons nose. When you ingest these harmful compounds in large amounts or over a longer period of time, they may cause a variety of health issues, including physical, muscular, and neurological problems, as well as birth defects (26, 28). They cannot be stopped by pinching your nostrils. Your healthcare provider will figure out the best treatment for you based on: Vitamin B12 deficiency anemia and folate deficiency anemia often occur together and can be hard to tell apart. Our website services, content, and products are for informational purposes only. A measuring cup is ideal because it will help a medical professional know how much blood you've lost. However, a recent study suggests that up to 65% of them contain nutrient levels above the safe upper limits (UL) for children (5). I also wanted to consult you for my father. 2023 Dotdash Media, Inc. All rights reserved. For this medicine, the following should be considered: Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. However, in some cases, nosebleeds occur due to underlying conditions. Is the ketogenic diet right for autoimmune conditions? Allow it to dissolve in your mouth without chewing. Scientists need to conduct more research to evaluate the effects of nutrient intakes that fall between the DRI and UL. Analytical cookies are used to understand how visitors interact with the website. (2020). It is always best to seek emergency medical care after a major accident. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. Your dose needs may change if you become pregnant, if you breastfeed, or if you eat a vegetarian diet. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. A fast heart rate may be a symptom of vitamin B-12 deficiency. Although many bold numbers are there, they are not abnormal, so no need to worry about those. So, you need to repeat TSH after 2 to 3 months. The heart may start to beat faster to make up for the reduced number of red blood cells in the body. Most are not serious, but sometimes a nosebleed can indicate a more severe underlying condition, such as leukemia. With these types of anemia, the red blood cells dont develop normally. What do we do in case her BP shoots up? A severe injury to the nose may swell and make breathing difficult. This medicine is given to treat or prevent a vitamin B12 deficiency in people with pernicious anemia or other medical conditions, both in an oral tablet and injectable form (to increase absorption). Take with a full glass of water. It is very important that your doctor check the progress of you or your child at regular visits. But if you take supplements, you might ingest more than your body needs. You can discuss this with your doctor. If a person cannot get enough from their usual diet, fortified foods and other dietary supplements may help. Biologically active vitamin B12 compounds in foods for preventing deficiency among vegetarians and elderly subjects [Abstract]. Nutritional factors affecting mental health. It could be from your diet if you eat a lot of meat, eggs, and seafood. Multivitamins can become contaminated with harmful compounds, such as arsenic or lead. Inflammation from a sinus infection can irritate nasal tissue and cause a nosebleed. It is possible that this is a sign of a more serious problem. It is possible that elevated levels of cobalamin are a sign of a serious, life threatening disease. However, this vitamin can interact with various medications, including antibiotics and blood thinners. However, children are likely to experience them at much lower doses than adults. However, people who combine multivitamins with other supplements or eat significant amounts of fortified foods may exceed the UL for certain nutrients. You should also seek emergency care if you were in a serious accident, have high blood pressure, or can taste blood. Like fat-soluble vitamins, minerals can accumulate in the body if you take them in excess, possibly causing harmful effects. For instance, excess intakes of vitamin A may cause headaches, liver damage, weaker bones, and birth defects (11). I have seen your dad's reports (attachment removed to protect patient identity). More rapid wound recovery, delayed aging, help with complications from diabetes and better immune function are just a few of the benefits that may be provided by the power of vitamins C and D. It is possible that your nose will bleed if you have too high of a intake of vitamin C. Blood clotting can be affected by deficiency of factor II, V, or VII. Take all of your medications as directed. The most common example is chemotherapy treatment. Thank you for replying. Moreover, excess amounts of vitamin E may result in bleeding, diarrhea, weakness, blurred vision, and fertility problems (1, 13). Kristin Hayes, RN, is a registered nurse specializing in ear, nose, and throat disorders for both adults and children. Nonetheless, some people may still experience a few side effects when taking multivitamins. 2013;42:4. doi:10.1186/1916-0216-42-4, Pacagnella RC, Souza JP, Durocher J, et al. Without enough oxygen, your body cant work as well. 2018;115(1-02):12-22. doi:10.3238/arztebl.2018.0012, Murer K, Ahmad N, Roth BA, Holzmann D, Soyka MB. If you are gushing blood, call 911. A vitamin B-12 deficiency can lead to both physical and psychological problems. The following chart outlines both the DRI and UL for each nutrient of concern for adults. These longer-term side effects may include birth defects and liver, heart, and cognitive issues (11, 20, 21, 27, 28). By Kristin Hayes, RN Vitamin D vs. D3 Ozempic Spring Allergies Sleep Schedules Health A-Z . There was a correlation between the intake of vitamins B12 and blood pressure. Other types of megaloblastic anemia may be associated with type 1 diabetes, thyroid disease, and a family history of the disease. bleeding from the gums or nose blue lips and fingernails chest pain cough Medical News Today only shows you brands and products that we stand behind. Also write down any new instructions your provider gives you. Ask your health query to a doctor online? Home. Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet. The Difference Between a Runny Nose and a CSF Leak. For instance, overly high intakes of certain minerals, such as iron, copper, magnesium, and zinc, can cause stomach upset, constipation, diarrhea, nausea, vomiting, stomach pain, and headaches (4, 15, 16, 17, 18). You can upload files and images in the next step. Taking vitamins is part of the daily routine of millions of people worldwide. It does not store any personal data. Symptoms of vitamin B-12 deficiency include fatigue, low mood, and nerve problems. Also know what the side effects are. They tend to disappear as your body gets used to taking the multivitamin. You may have a broken . easy bruising or bleeding (nosebleeds, bleeding gums); a light-headed feeling, like you might pass out; chest pain or tightness, fasts heartbeats. This product is available in the following dosage forms: In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. Its possible to cause vomiting and damage to the bile duct if you have a high dose. However, vitamin B12 shots may have other side effects. Multivitamins containing high levels of iron, copper, and zinc may also prevent the body from absorbing other nutrients you consume (15, 16, 17). Your doctor may recommend vitamin B12 supplements for medical conditions that arent listed in this guide. Normal daily requirements of vitamin B12 vary according to age. You can find more information in these exhaustive nutrient tables (22). And they are shaped like an oval, not round like healthy red blood cells. you get nosebleeds that you cannot stop and that last longer than 10 minutes you have blood in your vomit or you're coughing up blood you get severe headaches you have any bleeding from a cut or injury that will not stop or slow down These are symptoms of serious bleeding. Drugs A-Z provides drug information from Everyday Health and our partners, as well as ratings from our members, all in one place. A serious vitamin B 12 deficiency can be corrected two ways: weekly shots of vitamin B 12 or daily high-dose B 12 pills. Colds, allergies, and frequent nose-blowing can also irritate the lining of your nose, resulting in a nosebleed. Shall I take Aspirin with honey to induce period? Gastric cancer. The first step of home treatment is to stop the bleeding. The nasal bleeding has started again, although, the bleeding is only afew drops since she has stopped Ecosprin and Oblong. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. Other factors that may cause multivitamin side effects, Do Multivitamins Work? Posterior nosebleeds are more likely to cause bleeding in both nostrils. Excess sciency of sciency of sciency of sciency of sciency of sciency of sciency of sciency of sciency . Do not take two doses at one time. Bleeding from one nostril is the most common symptom of a nose bleed. This can be achieved with a daily dose of 500mg. Boosting your B 12. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Last medically reviewed on January 23, 2019, Vitamin B12 is crucial for the formation of red blood cells and the healthy functioning and health of nerve tissue. Having too much homocysteine in the brain may cause mental health problems. If you have a nosebleed that lasts longer than 20 minutes, you should seek medical attention. Let me know if I need to take any other steps. As with other nutrients, the best way for most people to get vitamin B-12 is in the diet. Depending on the nutrient, this will influence the speed and severity at which you may experience side effects. I am attaching the most recent report. Is she non-vegetarian? His hands shiver a bit. Anemia that results from vitamin B-12 deficiency may cause a person to feel a little short of breath. Sit upright so that the head is higher than the heart. Do you have a history of dizziness, weakness, and stroke? If you can taste blood, you may have a posterior bleedthat is, one that comes from the back of the nose. before touching your nose, mouth, or eyes; . Can diet help improve depression symptoms? B12 helps produce a substance called myelin in the nervous system, which coats and shield. There are a number of hematologic disorders that can cause elevated levels of cobalamin. Store at room temperature away from moisture, heat, and light. You should not use this medicine if you are allergic to cobalt or if you have Leber's disease. This article reviews the safety of taking vitamins, as well as the side, Folic acid is a synthetic version of folate (vitamin B9), an essential vitamin that your body cannot make itself. Organ meats are the organs of animals that humans prepare as food. This is not a complete list of side effects and others may occur. Currently, researchers dont fully understand the effects and safety of long-term intakes of vitamin or mineral dosages that fall between the DRI and UL. Functional Endoscopic Sinus Surgery: Everything You Need to Know. One study even linked low vitamin B-12 levels to an increased risk of Alzheimers disease, vascular dementia, and Parkinsons disease. That said, multivitamins provide a good alternative source for those who are unable to meet their nutrient requirements through diet alone. If you develop any side effects from taking vitamin B-12, you can stop taking the supplement and the symptoms should subside. Taking too much can cause side effects like nausea, headache, dizziness, and in rarely, blood clots or cancer. See your doctor if you have bothersome side effects that dont go away once you stop taking the supplements. These issues include difficulty thinking or reasoning and memory loss. Blood vessels in the eye can be affected as well, leading to blurry vision or even loss of vision. If you get a nosebleed and you have a history of high blood pressure, contact your healthcare provider. 2017;4(1):131-134. doi:10.1002/ams2.239, Chuda RR, Castillo SM, Poddutoori P. Hypertensive crises. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Anterior nosebleeds are the most common type of nosebleed. If you think youre experiencing any side effects, make sure to bring them up with your healthcare provider as promptly as possible. Read our, Your Bloody Nose Was Caused by Severe Trauma. Certain side effects are more likely to occur than others when youre taking multivitamins. This article discusses whether you should be concerned about taking multivitamins. Some people may also experience severe allergic reactions to certain multivitamins, although this is very rare. Dry air from indoor heating or outdoor cold can dry out the lining of . Know why a test or procedure is recommended and what the results could mean. The form of vitamin B9 in the table above is called folate, and you can get it from natural sources not multivitamins. Consuming multivitamins that contain nutrient levels exceeding the daily UL may result in an array of side effects. Megadoses of some nutrients may not be particularly harmful, but extremely high doses of certain nutrients can seriously harm your health (4). Myelin is a protective coating that shields the nerves and helps them transmit sensations. This may explain why experts report that children who consume multivitamins have a high risk of exceeding the UL, particularly for vitamin A, folic acid, and zinc (4). Cerner Multum provides the data within some of the Overview, Uses, Warnings, Side Effects, Pregnancy, Interactions, Dosage, Overdose, and Images sections. This symptom occurs because the vitamin plays a crucial role in the nervous system, and its absence can cause people to develop nerve conduction problems or nerve damage. Vitamin B12 is an important water-soluble vitamin that many people are deficient in. According to the National Institutes of Health, the recommended dietary amounts (RDAs) are as follows: If youre over the age of 50, you should try to get your RDA by eating foods with B-12 or by taking a supplement containing 25 to 100 mcg of B-12.
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