Sa1100 Randomized Open Label Trial Comparing Efficacy of Oral Versus Intramuscular Vitamin B12 Supplementation for Treatment of Vitamin B12 Deficiency

Introduction: An unusual case of a 19 year old female, presenting with fever, pallor and hepatosplenomegaly for one month. She had microcytic anemia on peripheral smear examination but her bone marrow aspiration & biopsy revealed a hypercelluar marrow with megaloblastic erythroid hyperplasia. Resolution of fever within 48 hours of Vitamin B12 supplementation, initiated in view of the megaloblastic bone marrow picture & low serumVitamin B12 level, suggests a causal association. Conclusion: Vitamin B12 deficiency seems to be an unusual cause of PUO (Pyrexia of unkown origin) which should be ruled out in every case of PUO.

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Vitamin B12 supplementation did not improve cognition but reduced delirium in demented patients with vitamin B12 deficiency

Archives of Gerontology and Geriatrics ◽

10.1016/j.archger.2007.05.001 ◽

2008 ◽

Vol 46 (3) ◽

pp. 273-282 ◽

Cited By ~ 20

Author(s):

Timothy Kwok ◽

Jenny Lee ◽

Linda Lam ◽

Jean Woo

Keyword(s):

Vitamin B12 ◽

Vitamin B12 Deficiency ◽

B12 Deficiency ◽

Vitamin B12 Supplementation

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Long-term Metformin Use and Vitamin B12 Deficiency in the Diabetes Prevention Program Outcomes Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2015-3754 ◽

2016 ◽

Vol 101 (4) ◽

pp. 1754-1761 ◽

Cited By ~ 120

Author(s):

Vanita R. Aroda ◽

Sharon L. Edelstein ◽

Ronald B. Goldberg ◽

William C. Knowler ◽

Santica M. Marcovina ◽

...

Keyword(s):

Vitamin B12 ◽

Prevention Program ◽

Diabetes Prevention ◽

Vitamin B12 Deficiency ◽

Diabetes Prevention Program ◽

Open Label ◽

Metformin Group ◽

B12 Deficiency ◽

Outcomes Study

Abstract Context: Vitamin B12 deficiency may occur with metformin treatment, but few studies have assessed risk with long-term use. Objective: To assess the risk of B12 deficiency with metformin use in the Diabetes Prevention Program (DPP)/DPP Outcomes Study (DPPOS). Design: Secondary analysis from the DPP/DPPOS. Participants were assigned to the placebo group (PLA) (n = 1082) or the metformin group (MET) (n = 1073) for 3.2 years; subjects in the metformin group received open-label metformin for an additional 9 years. Setting: Twenty-seven study centers in the United States. Patients: DPP eligibility criteria were: elevated fasting glucose, impaired glucose tolerance, and overweight/obesity. The analytic population comprised participants with available stored samples. B12 levels were assessed at 5 years (n = 857, n = 858) and 13 years (n = 756, n = 764) in PLA and MET, respectively. Interventions: Metformin 850 mg twice daily vs placebo (DPP), and open-label metformin in the metformin group (DPPOS). Main Outcome Measures: B12 deficiency, anemia, and peripheral neuropathy. Results: Low B12 (≤ 203 pg/mL) occurred more often in MET than PLA at 5 years (4.3 vs 2.3%; P = .02) but not at 13 years (7.4 vs 5.4%; P = .12). Combined low and borderline-low B12 (≤ 298 pg/mL) was more common in MET at 5 years (19.1 vs 9.5%; P < .01) and 13 years (20.3 vs 15.6%; P = .02). Years of metformin use were associated with increased risk of B12 deficiency (odds ratio, B12 deficiency/year metformin use, 1.13; 95% confidence interval, 1.06–1.20). Anemia prevalence was higher in MET, but did not differ by B12 status. Neuropathy prevalence was higher in MET with low B12 levels. Conclusions: Long-term use of metformin in DPPOS was associated with biochemical B12 deficiency and anemia. Routine testing of vitamin B12 levels in metformin-treated patients should be considered.

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Prevalence of vitamin B12 deficiency among individuals with type 2 diabetes mellitus in a South Indian rural community

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20180104 ◽

2018 ◽

Vol 7 (2) ◽

pp. 309 ◽

Cited By ~ 2

Author(s):

Shailendra D. ◽

Rizwan Kalani ◽

K. M. Venkat Narayan ◽

Dorairaj Prabhakaran ◽

Nikhil Tandon ◽

...

Keyword(s):

Vitamin B12 ◽

Rural Community ◽

Odds Ratio ◽

Complete Blood Count ◽

Serum Vitamin ◽

Vitamin B12 Deficiency ◽

Oral Vitamin ◽

South Indian ◽

B12 Deficiency ◽

Vitamin B12 Supplementation

Background: To estimate the prevalence of vitamin B12 deficiency in a rural south Indian community and to evaluate the association between metformin use and prevalent vitamin B12 deficiency in people with T2DM stratified by oral vitamin B12 supplementation.Methods: Using a cross sectional study design, a random sample of people with T2DM (N=438) was recruited from a rural community. Vitamin B12 deficiency was defined as serum B12 ≤200pg/ml. Data on metformin dose, duration of use, oral vitamin B12 supplementation, and diet were collected. Laboratory measurements included complete blood count, tests for hepatic, renal, and thyroid function, as well as serum vitamin B12 levels and HbA1c.Results: The prevalence of vitamin B12 deficiency in people with T2DM was 11.2% (95% Confidence Interval (CI) 8.2%-14.1%). The odds of vitamin B12 deficiency in patients receiving a metformin dose of 2 grams/day were 4 times higher compared to those receiving ≤1 gram/day, after adjusting for oral B12 supplementation (odds ratio 4.2;95% CI 1.5-11.8). The odds of vitamin B12 deficiency in those taking metformin and receiving oral vitamin B12 supplementation were lower compared to those on metformin and not receiving vitamin B12 supplementation (adjusted odds ratio 0.20; 95% CI 0.06-0.70).Conclusions: Vitamin B12 deficiency affects 1 in 10 people with T2DM, is associated with higher dose metformin use, and oral vitamin B12 supplementation mitigates B12 deficiency in this group.

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Unusual presentation of vitamin B12 deficiency in a 3 month old infant: presentation with hemolysis and thrombocytopenia

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20203186 ◽

2020 ◽

Vol 7 (8) ◽

pp. 1816

Author(s):

Poornima Shankar ◽

Anil H.

Keyword(s):

Vitamin B12 ◽

Vitamin B12 Deficiency ◽

Well Being ◽

The Body ◽

Elevated Bilirubin ◽

B12 Deficiency ◽

Laboratory Investigations ◽

Vitamin B12 Supplementation ◽

Poor Weight Gain

A 3 month old infant exclusively breast fed presented with vomiting and poor weight gain with purpuric and echymotic patches all over the body. The child also had hyperpigmentation over knuckles and icterus. Laboratory investigations revealed severe dimorphic anemia with thrombocytopenia, elevated bilirubin and LDH levels and severe vitamin B12 deficiency. Following vitamin B12 supplementation there was improvement in well-being including feed tolerance, icterus resolved and in follow up lab studies there was improvement in hemoglobin and platelet counts along with reduced bilirubin levels. Through this case report we want to emphasize the possibility of vitamin B12 deficiency presenting as hemolytic anemia and psuedothrombotic microangiopathy.

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Vitamin B12 Supplementation in Treating Major Depressive Disorder: A Randomized Controlled Trial

The Open Neurology Journal ◽

10.2174/1874205x01307010044 ◽

2013 ◽

Vol 7 (1) ◽

pp. 44-48 ◽

Cited By ~ 22

Author(s):

Ehsan Ullah Syed ◽

Mohammad Wasay ◽

Safia Awan

Keyword(s):

Treatment Group ◽

Vitamin B12 ◽

Controlled Trial ◽

Vitamin B12 Deficiency ◽

Major Depressive ◽

Randomized Controlled ◽

Depressed Patients ◽

B12 Deficiency ◽

Vitamin B12 Supplementation

Background/Objective: Recent literature has identified links between vitamin B12 deficiency and depression.We compared the clinical response of SSRI-monotherapy with that of B12-augmentation in a sample of depressed patients with low normal B12 levels who responded inadequately to the first trial with the SSRIs. Methods: Patients with depression and low normal B12 levels were randomized to a control arm (antidepressant only) or treatment arm (antidepressants and injectable vitamin B12 supplementation). Results: A total of 199 depressed patients were screened. Out of 73 patients with low normal B12 levels 34 (47%) were randomized to the treatment group while 39 (53%) were randomized to the control arm. At three months follow up 100% of the treatment group showed at least a 20% reduction in HAM-D score, while only 69% in the control arm showed at least a 20% reduction in HAM-D score (p<0.001). The findings remained significant after adjusting for baseline HAM-D score (p=0.001). Conclusion: Vitamin B12 supplementation with antidepressants significantly improved depressive symptoms in our cohort.

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Vitamin B12 and Holotranscobalamin Levels in Diabetic Peripheral Neuropathy Patients

Indian Journal of Medical Biochemistry ◽

10.5005/jp-journals-10054-0004 ◽

2016 ◽

Vol 20 (1) ◽

pp. 16-20

Author(s):

Mohammed Noorjahan ◽

Kandregula Madhavi ◽

Chandran Priscilla ◽

Shaik A Jabeen

Keyword(s):

Peripheral Neuropathy ◽

Diabetic Neuropathy ◽

Vitamin B12 ◽

Diabetic Peripheral Neuropathy ◽

Vitamin B12 Deficiency ◽

Biologically Active ◽

Significant Difference ◽

B12 Deficiency ◽

Vitamin B12 Supplementation

ABSTRACT Diabetic neuropathy is the most common and debilitating microvascular complication leading to nontraumatic amputations. Identifying the role of vitamin B12 in the etiology of neuropathy is crucial because simple vitamin B12 replacement may reverse neurologic symptoms if confirmed. Large proportion of vegetarians and patients on metformin have been associated with lowering of vitamin B12 levels. We have undertaken study on 60 vegetarian subjects between the age of 30 and 60 years, 20 healthy controls, 20 type 2 diabetes mellitus patients who were on metformin with peripheral neuropathy (DMWN), and 20 diabetics without peripheral neuropathy (DMWON). Vitamin B12, homocysteine, and folate levels were measured, and holotranscobalamin (holoTC) is also included, to improve the diagnosis of tissue vitamin B12 status, as holoTC is the biologically active fraction and more sensitive index of vitamin B12 status than total vitamin B12 itself. Complete history and clinical evaluation for neuropathy and electroneuromyography were recorded. Results In the DMWN group, vitamin B12 levels were significantly higher than in the DMWON group and controls [1013 (564-1501) pmol/l, 387 (245-731) pmol/l, and 305 (234-472) pmol/l respectively]. Similarly, serum holoTC was also found to be significantly higher in the DMWN [203.8 (129-300) pmol/l] group compared with the DMWON [94.4 (42.2-230.6) pmol/l] group and controls [74 (40-170) pmol/l]. Whereas mean levels of homocysteine and folate did not show any significant difference between groups, significant increase in fasting blood sugar and HbA1c was seen in the DMWN group compared with DMWON group and controls. Duration of diabetes is also significantly more in DMWN group compared with DMWON group. Conclusion We found that vitamin B12 and holoTC levels were high in patients with DMWN and DMWON groups compared with controls. Our study demonstrated that peripheral neuropathy was not associated with vitamin B12 deficiency in diabetics. These findings merit further research on a larger population to investigate into the cause of diabetic neuropathy, the factors involved, and benefit of vitamin B12 supplementation in these patients. Key messages Vitamin B12 status has no association with diabetic peripheral neuropathy. How to cite this article Noorjahan M, Madhavi K, Priscilla C, Jabeen SA. Vitamin B12 and Holotranscobalamin Levels in Diabetic Peripheral Neuropathy Patients. Indian J Med Biochem 2016;20(1):16-20.

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Generation of retractive spine circuits in the process of vitamin B12 deficiency

European Journal of Clinical and Experimental Medicine ◽

10.15584/ejcem.2020.2.9 ◽

2020 ◽

Vol 18 (2) ◽

pp. 131-134

Author(s):

Patrycja Mucha ◽

◽

Natalia Leksa ◽

David Aebisher ◽

Sabina Galiniak ◽

...

Keyword(s):

Spinal Cord ◽

Vitamin B12 ◽

Neurological Complication ◽

Vitamin B12 Deficiency ◽

Careful Analysis ◽

Neurological Status ◽

B12 Deficiency ◽

Spastic Paresis ◽

Characteristic Features ◽

Vitamin B12 Supplementation

Introduction. Subacute degeneration of the posterior and lateral spinal cord is a rare neurological complication of B12 avitaminosis. Aim. In this paper, we present the case of a 65-year-old man who, in the course of long-term vitamin B12 deficiency associated with atrophic gastritis, developed a severe set of neurological symptoms that are part of the retinal spinal cord degeneration with characteristic features in MR imaging of the cervical spine in the form of an inverted “V mark” ‘in axial images and typical localization in the spinal cord. Description of the case. After careful analysis of the syndrome and making an early diagnosis, parenteral vitamin B12 supplementation began, resulting in improved neurological status, laboratory parameters as well as regression of changes in magnetic resonance imaging. Conclusion Significant symptoms of this syndrome are paresthesia in the distal parts of the limbs, ataxia, spastic paresis.

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