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An alternative: Measuring urine levels of xanthurenic acid following intake of a high dose of tryptophan

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The British Society for Haematology emphasises that treatment should not be delayed whilst awaiting confirmatory test results if clinical suspicion of B12 deficiency is high, particularly when neurological symptoms are present

This phenomenon, sometimes referred to as early worsening of diabetic retinopathy, appears to be related to the magnitude and speed of glucose lowering rather than a direct effect of the medication