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According to a 2017 systematic review in the Journal of Clinical Nursing confirming that aspiration before subcutaneous injection does not reduce adverse events, subcutaneous injections carry a distinct pharmacokinetic profile that intramuscular delivery disrupts, which is why correct angle and depth matter for predictable results

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High levels of B12 are a warning sign: While low serum cobalamin levels do not necessarily imply deficiency, an abnormally high serum cobalamin level forms a warning sign requiring exclusion of a number of serious underlying pathologies