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Diagnosis is not always straightforward as serum levels can be falsely high or normal. [10] Elevated methylmalonic acid levels may also indicate a deficiency. [2] Individuals with low or marginal values of vitamin B 12 in the range of 148–221 pmol/L (200–300 pg/mL) may not have classic neurological or hematological signs or symptoms. [2]
Reduced serum levels of vitamin B 12 occur in up to 30% of people taking long-term anti-diabetic metformin. [105] [106] Deficiency does not develop if dietary intake of vitamin B 12 is adequate or prophylactic B 12 supplementation is given. If the deficiency is detected, metformin can be continued while the deficiency is corrected with B 12 ...
A diagnosis of vitamin B 12 deficiency is determined by blood levels lower than 200 or 250 picograms per ml (148 or 185 picomoles per liter). [3] Some people can have symptoms with their normal levels of the vitamin, or may have low levels despite having no symptoms. [5] Other tests may be done to ensure individuals status. [3]
Administration of nitrous oxide anesthesia can precipitate subacute combined degeneration in people with subclinical vitamin B 12 deficiency, while chronic nitrous oxide exposure can cause it even in persons with normal B 12 levels. Posterior column dysfunction decreases vibratory sensation and proprioception (joint sense).
Vitamin B12 deficiency anemia: E53.8: 13905: Vitamin B12 deficiency anemia occurs when a "lower-than-normal" amount of the vitamin B12 is available within the body, leading to a decreased production of healthy red blood cells. [7] Vitamin B12 deficiency anemia due to intrinsic factor deficiency: D51.0
Cholestasis can be excluded by normal levels of bile acids in plasma, the absence of lactate dehydrogenase, low levels of conjugated bilirubin, and ultrasound scan of the bile ducts. Vitamin B12 deficiency - elevated bilirubin levels (and MCV counts above 90–92) can be associated with a vitamin B12 deficiency.
The Schilling test has multiple stages. [3] As noted below, it can be done at any time after vitamin B 12 supplementation and body store replacement, and some clinicians recommend that in severe deficiency cases, at least several weeks of vitamin repletion be done before the test (more than one B 12 shot, and also oral folic acid), in order to ensure that impaired absorption of B 12 (with or ...
In a newly diagnosed vitamin B 12-deficient patient, normally defined as when serum levels are less than 200 pg/ml, daily IM injections of hydroxocobalamin up to 1,000 μg (1 mg) per day are given to replenish the body's depleted cobalamin stores. In the presence of neurological symptoms, following daily treatment, injections up to weekly or ...