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It could also be the base fluid

Tom Biernacki, DPM, FACFAS answers: Burning feet that worsen at night classic Grierson-Gopalan syndrome are most commonly caused by peripheral neuropathy from diabetes, vitamin B12 or B1 deficiency, or chronic alcohol use

Oral administration also makes sense when shoulder issues accompany gut problems

Gwyer, D., Wragg, N.M
