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Finally, hepatic impairment can affect gluconeogenesis and medication metabolism, though tirzepatide itself does not require dose adjustment in liver disease

This may be due to liver or kidney disease, or certain cancers and blood disorders: The aetiological profile of high serum cobalamin predominantly encompasses severe disease entities for which early diagnosis is critical for prognosis

[PMC free article: PMC5192543] [PubMed: 28090343] 19