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Any elderly patient experiencing new or worsening neurological symptoms despite B12 treatment should be referred back to their GP for reassessment, as alternative diagnoses must be considered

Patients with rhinorrhea (rhinitis) who are receiving the intranasal formulations of cyanocobalamin may experience decreased medication absorption secondary to nasal discharge

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[11] [9] This explains why therapeutic doses are substantially higher than dietary requirements

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Neurophysiological examination, using electrophysiology or ultrasonography, performed in certain circumstances, should correlate with the history and findings in clinical examination of the person with CTS