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The key variables are form, dose, and timing

These are cases typically involve infants who were fed b12-deficient diets (usually Vegan)

It is produced predominantly in the liver in response to growth hormone (GH) stimulation, and it mediates a substantial fraction of GHs anabolic and growth-promoting effects

Z.BozkurtM.YrkerS.YeniseyC.et al (2010)

Thioctic acid should not be injected at a rate of more than 50 mg (2 mL of injectable solution) per minute