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Saturday, October 29, 2011

A Family Doctor's Tale - VITAMIN B12 DEFICIENCY

DOC I HAVE VITAMIN B12 DEFICIENCY

Vitamin B12 (cyanocobalamin) Deficiency is a medical condition caused by the deficiency of the human body of Vitamin B12 as a result of inadequate dietary intake or impaired absorption.

Vitamin B12 is present in all living human tissues as an important  ingredient in the production of red blood cells.

Functions of Vitamin B12:
1.It is important in metabolism of labile methyl groups example biosynthesis of choline and methionine

2.It maintains glutathione in reduced state

3.It is important in the maturation of erythrocytes, neurologic function and growth.

Vitamin B12 is found primarily in
1.animal sources - red meat, liver, milk, egg yolks
2.vegetable sources: Vitamin B12 is found in fresh green and yellow vegetables, cereals

Optimal requirements of Vitamin B12 are:
1.adults and children above puberty: 1 mcg to 2 mcg daily
Pregnant mother and elderly may need double the amount.
2.Infants and children before puberty: 0.5 mcg to 1 mcg daily

Causes:
Vitamin B12 Deficiency occurs
1.when there is Vitamin B12 deficiencies due to
a.diet - starvation, vegetarians

b.malabsorption as in celiac syndrome, sprue or hepatitic cirrhosis


c.intestinal parasites such as diphyllobothrium latum


d.pernicious anemia when the gastric mucosa  cannot produce the intrinsic factor necessary for vitamin B12 absorption

2.Severity of Vitamin B12 deficiency is inversely related to age.
It is more common in elderly people.

Symptoms:
1.Vitamin B12 Deficiency is a silent disease in the early stages.
People with Vitamin B12 Deficiency often do not know that they have the condition.

2.Blood - anemia with pallor, shortness of breath and weakness


3.Brain -subacute combined degeneration of spinal cord and brain

  - numbness of hands and feet

                 -giddiness

                 -developmental delays and failure to thrive in children

4.Mental -depression, fatigue, mental confusion

Diagnosis:
1.Blood Vitamin B12 levels are low

Complications:

Serious complications of vitamin B12 deficiency include:

1.anemia

2.nerve damage

3.abnormalities in growth and development

4.brain dysfunction including depression and dementia

Treatment:
The goal of Vitamin B12 Deficiency treatment is the prevention of pernicious anemia and peripheral neuropathy.

Therefore, prevention of Vitamin B12 Deficiency is as important as treatment. Vitamin B12 Deficiency treatment and prevention measures are:

Medications:
Vitamin B12 supplements
1.Vitamin B12 is given at 100 mcg per day by injection which may be a life long treatment in cases when the body cannot absorb oral Vitamin B12


2.Oral Vitamin B12 tablets can be given in people who can absorb the vitamin in the stomach.

 It can also be given sublingually or through the nasal route.

3.treat the underlying causes such as gastric problems and gastrectomy, malabsorption, decreased intake in the case of vegetarians

Side effects of Vitamin B12 are:
1.Vitamin B12 does not give side effects because being water soluble it is excreted easily in the urine if large doses are ingested

Prognosis:
1.good response to treatment in Vitamin B12 deficiency in early stages.

2.treat underlying cause such as malabsorption to get a good response in the treatment of Vitamin B12 Deficiency.

Prevention:
take more red meat, liver, egg yolks, cereals and fresh green vegetables.

Vegetarians should take Vitamin B12 supplements.

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