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This case will describe a59-year-old female presenting with elevated anion gap metabolic acidosis with no discernible classical cause, chronic acetaminophen use, malnourishment, and severe hypothyroidism with 5-oxoprolinemia after extensive investigation of other causes

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It is not intended as a standalone therapeutic dose for severe B12 deficiency, which would require separate supplementation at different intervals and doses under veterinary guidance

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Chronic alcohol use further exacerbates this issue, resulting in chronically low levels of glutathione