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NaCl helps the osmotic component, but a buffered version of NAD+ addresses the actual cause. Tesamorelin is the one people get backwards: its FDA label specifies sterile water, but that is regulatory convenience, not the better diluent

[5] Importantly, if both B12 and folate deficiencies are present, B12 should be corrected first to avoid potentially worsening neurological symptoms

Kidney Dysfunction: While the kidneys do not directly excrete vitamin B12 efficiently, impaired renal function may lead to elevated serum B12 levels by reducing the clearance of B12-binding proteins or altering their metabolism, thereby contributing to B12 accumulation 8

Bleeding is possible if a blood vessel is pierced