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There are no other absolute contraindications reported for hydroxocobalamin use in deficiency states, but caution is advised in individuals with conditions such as early Lebers optic neuropathy (a rare hereditary optic atrophy) due to the theoretical risk of worsening vision

The form, dose, and timing are worth recording, and further workup becomes necessary if the elevation persists once those sources are accounted for, or if symptoms, examination findings, or other labs raise concern

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