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For children, Walsh modified his formula taking into account B12 absorption amounts found in children by Hjelt and Krasilnikoff (Hjelt, 1986)

I usually pair it with metabolic basics: continuous glucose monitoring if appropriate, structured protein intake, and a structured resistance training program

Feedback from audits should be constructive and used to update training modules and refine SOPs

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Elderly patients may be more sensitive to the medications effects and may require slower titration or lower maintenance doses, particularly if they have reduced renal function or are at higher risk for dehydration from gastrointestinal adverse effects