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While elevated MMA blood concentration is considered the specific indicator of deficiency (19), other clinical assays are often used as biomarkers of vitamin B 12 status sometimes in combination

Newborns (especially preterm) lack the ability to metabolize benzyl alcohol, leading to metabolic acidosis, respiratory distress, hypotension and (in reported cases) the often-fatal gasping syndrome. For this reason, only preservative-free sterile water (no benzyl alcohol) is used in pediatric or neonatal care