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Exam Cram
Exam Cram
B12 is absorbed in the terminal ileum, requiring intrinsic factor and helps maintain the nervous system- particularly the spinal dorsal column responsible for vibration, proprioception
Causes of B12 deficiency: dietary (vegans) or malabsorption (Crohn's, pernicious anaemia)
Presentation: symptomatic anaemia- lethargy, sob, palpitations; Peripheral Neuropathy- dorsal column, Dementia
Management: IM hydroxocobalamin( if malabsorptive) or PO cyanocobalamin replacement
Outline
Outline
Background
Background
B12 deficiency is one of the commonest nutritional deficiencies
Causes: poor intake/ diet, malabsorption: IBD, Coeliac Disease, increase losses: high output stoma/ chronic diarrhoea, increase demand: Haemolytic Anemias
Complications:
Subacute combined degeneration of spinal cord- Peripheral Neuropathy, Sensory Ataxia
Reversible Dementia
Assessment
Assessment
History
Lethargy
Unsteadiness on feet
Lower limb numbness
Examination
Dorsal column: loss of proprioception, vibration (peripheral neuropathy)
Ataxia, Upward plantars
Reduced cognition
Investigations
Macrocytic Anaemia
Low B12
Diagnosis
Diagnosis
Diagnostic criteria: low serum B12
Differentials: low folate
Classification (aetiology)
Poor diet - vegan
Poor absorption / increased losses- Crohn's Disease , Coeliac Disease
Management
Management
Acute
IM B12 replacement- 6 doses over two weeks
Long term
IM B12 injection 3 monthly OR
PO B12
References and Resources
References and Resources
Created in 2024.
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