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Diarrhoea (defined as three or more loose or watery stools per day) is an uncommon side effect of vitamin B12 supplementation , though it is listed as a rare or uncommon adverse reaction in the official product information for both oral cyanocobalamin and injectable hydroxocobalamin preparations

The powder may have degraded before reconstitution due to improper storage, high temperature exposure, or moisture infiltration into the sealed vial

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NICE guidance distinguishes between dietary deficiency and deficiency caused by malabsorption conditions such as pernicious anaemia