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B12 deficiency may occur due to poor diet, vegetarian/vegan lifestyle, malabsorption, aging, digestive disorders, or medications like metformin and PPIs

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Use correct administration rate

It also could not account for unstructured lifestyle changes patients may have made on their own, reasons for stopping the medication, or use of compounded versions of these drugs

30 Apart from these, efflux pumps are also a potential mechanism for antibiotic resistance