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[16] Although cyanocobalamin lacks a defined upper-toxicity threshold due to its water solubility and renal elimination, exceptionally high cumulative doses have been temporally associated with acneiform eruptions, altered potassium homeostasis, and theoretical thrombotic risk, emphasizing the importance of evidence-based dosing

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doi: 10.1016/j.arcmed.2015.05.005 226 ZhouFMaiTWangZZengZShiJZhangFet al