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Low levels of the zinc-dependent enzyme alkaline phosphatase (ALP)---included in a comprehensive metabolic panel---may help reveal a functional zinc deficiency
1.5 mg hydroxocobalamin acetate
Also, advise of any health or medication changes
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Note that unlike other water-soluble vitamins, B12 can be stored in the liver for a long time, so it might be years before B12 deficiency symptoms start appearing
The panel agreed that initial treatment should be parenteral for severe cases, while high-dose oral B12 can be considered for maintenance
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