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In the UK, B12 replacement is typically administered via intramuscular hydroxocobalamin injections for patients with confirmed deficiency, particularly those with malabsorption or pernicious anaemia, as specified in the BNF and NICE CKS guidance on B12 and folate deficiency anaemia

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Vegan diets, excessive alcohol use, certain medications, aging, and certain stomach diseases all raise the risk of vitamin B12 insufficiency