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Consider intramuscular vitamin B 12 injections instead of oral replacement for suspected or confirmed vitamin B 12 deficiency caused by diet if: The person has another condition that may deteriorate rapidly and have a major effect on their quality of life (for example, a neurological or hematological condition such as ataxia or anemia)

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Proper medical oversight during administration minimizes these risks

In other words, toxicity from B12 is extremely rare

It all goes down to absorption