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The conversion of methylmalonyl CoA to succinyl-CoA involves adenosylcobalamin as a cofactor, and a deficiency of this enzyme leads to an accumulation of methylmalonic acid

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But most patients find the traditional NHS or over-the-counter approach unsustainable

In one case study, a 5 month old breastfed infant of a vegan mother (who actually received a prenatal vitamin containing 96% of her daily needs of B12 throughout her pregnancy) presented with many of the above symptoms and required a 19 day hospital stay to stabilize

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