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That means: ⚠️ Hypokalemia can develop or worsen which can lead to: • Cardiac arrhythmias • Muscle weakness • QT prolongation • In severe cases, sudden cardiovascular instability This is a classic board-style pearl that many clinicians forget because B12 feels “benign.” But in profoundly deficient patients—especially those with severe megaloblastic anemia—repletion is metabolically active treatment