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Man rapidly declines from B12 deficiency after foot symptoms appear

Dr Dawn Harper on signs of vitamin B12 and vitamin D deficiency

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Vitamin B12’s contribution to the body is brought into sharp relief by its absence. Among other things, the vitamin supports the nervous system and helps to make red blood cells. Stripped of these functions, the body starts to behave in erratic ways.

A case study published in the American Society for Clinical Laboratory Science journal charts the negative effects of B12 deficiency.

The patient – a previously healthy 56-year-old white man – presented with progressive neuropathy and declining mental status over several months.

Neuropathy describes what happens when nerves in the body’s extremities, such as the hands, feet and arms, are damaged. It’s a complication of B12 deficiency.

According to the case report, the patient initially developed “numbness of his fingertips and the balls of his feet” and began to lose motor control of his hands, which manifested as dropping objects or flinging them as he tried to pick them up.

As symptoms progressed, he had visual tracking problems that were severe enough to interfere with driving a car, and he developed short-term memory loss and slowing of cognitive function.

Based on the clinical presentation and laboratory findings, a diagnosis of “psychomotor regression” due to B12 deficiency was made.

Psychomotor regression refers to the malfunction of cognitive functions and physical movement.

The patient was then treated with a series of B12 intramuscular injections, which resulted in “rapid remission” of associated neurological symptoms.

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In follow-up examinations, his B12 level was normalised in two months.

Commenting on the patient’s report, the case study authors wrote: “Diagnosis of B12 deficiency can be complicated since symptoms may be vague and lab test results can be equivocal.”

However, the patient’s symptomatic profile and responsiveness to treatment indicated B12 deficiency was the cause of his decline, they said.

“Fortunately, B12 therapy reversed his most severe neurological symptoms, although that may not always be the case.”

They added: “Since the reason for the deficiency is unknown, he will continue to receive B12 supplementation indefinitely.”

What causes B12 deficiency?

Pernicious anaemia is the most common cause of vitamin B12 deficiency in the UK.

Pernicious anaemia is an autoimmune condition, meaning your immune system attacks the cells in your stomach that produce the intrinsic factor – a protein needed to absorb vitamin B12.

Some people can develop a vitamin B12 deficiency as a result of not getting enough vitamin B12 from their diet.

According to the NHS, a diet that includes meat, fish and dairy products usually provides enough vitamin B12, but people who do not regularly eat these foods can become deficient.

How is B12 deficiency treated?

The treatment for vitamin B12 deficiency depends on what’s causing the condition.

Most people can be easily treated with injections or tablets to replace the missing vitamins.

There are two types of vitamin B12 injections:

  • Hydroxocobalamin
  • Cyanocobalamin.

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