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Respiratory symptoms including difficulty breathing or chest tightness are rare but serious reactions requiring immediate medical attention

Clinical Diabetes : A Publication of the American Diabetes Association, 37 (3), 227233

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Any disruptionLow stomach acid (hypochlorhydria), parietal cell loss (atrophic gastritis), IF deficiency (pernicious anemia), or ileal disease (Crohns)can compromise absorption, leading to deficiency risk