Anemia
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B12 Deficiency
The patient was ultimately found to have an elevated methylmoonic acid. Of note he was also complaining of weakness in his lower extremities and a recent history of poor balance at home. He was given a PO bolus of 2 milligrams B12 with additional parenteral supplementation while in the hospital. The macawmen causes of B12 deficiency are Crohn's disease because B12 is preferentially absorbed in terminal ileum and pernicious anemia where that's not a problem.
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