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Patients with Normal Intestinal Absorption: Where the oral route is not deemed adequate, initial treatment similar to that for patients with pernicious anemia may be indicated depending on the severity of the deficiency

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Risk of acid-base imbalance with high doses • Neuropathy relief: 2-6 weeks • Dermatitis improvement: 1-3 weeks • Homocysteine reduction: Within 48 hours • Nausea control: 6-24 hours (hyperemesis) • Seizure prevention: Immediate (in PD epilepsy) Maximum benefits require consistent therapy