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[6] The concentration-response profile of the collagen effect detectable at extremely low concentrations and independent of cell proliferation argues that the intact tripeptide is doing something more specific than passively supplying metal

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That means: Hypokalemia can develop or worsen which can lead to: Cardiac arrhythmias Muscle weakness QT prolongation In severe cases, sudden cardiovascular instability This is a classic board-style pearl that many clinicians forget because B12 feels benign. But in profoundly deficient patientsespecially those with severe megaloblastic anemiarepletion is metabolically active treatment