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Related Experiment Videos

Vitamin B12 replacement. To B12 or not to B12?

M D Delva1

  • 1Department of Family Medicine, Queen's University, Kingston, ON.

Canadian Family Physician Medecin De Famille Canadien
|May 1, 1997
PubMed
Summary

New diagnostic methods reveal vitamin B12 (cobalamin) deficiency in patients with neurological issues, even with normal B12 blood levels. Oral cobalamin is a viable treatment option.

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Area of Science:

  • Internal Medicine
  • Neurology
  • Clinical Diagnostics

Background:

  • Cobalamin (vitamin B12) deficiency diagnosis is controversial, with concerns of over-treatment.
  • Emerging evidence suggests tissue deficiency may occur without typical hematologic signs.

Purpose of the Study:

  • To review evidence for an expanded approach to identifying and treating cobalamin deficiency.
  • To address the diagnostic challenges and treatment controversies surrounding vitamin B12 deficiency.

Main Methods:

  • Literature search (1990-1995) including retrospective/prospective studies, surveys, and case series.
  • Analysis of diagnostic test accuracy and treatment outcomes.
  • No double-blind controlled treatment trials were identified.

Main Results:

  • Elevated serum homocysteine and methylmalonic acid indicate cobalamin tissue deficiency in patients with neuropsychiatric symptoms, even with normal B12 levels and no anemia.
  • Serum cobalamin tests lack sensitivity and specificity in the low-normal range.
  • Oral cobalamin is an effective, underutilized treatment alternative to injections.

Conclusions:

  • Family physicians should consider newer diagnostic markers for vitamin B12 deficiency, especially in patients with neuropsychiatric symptoms.
  • A clinical trial of treatment is supported for patients presenting with neuropsychiatric manifestations of potential cobalamin deficiency.

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