A 40-Year-Old Female with Balance Problems and Numbness After Bariatric Surgery

2016 ◽  
Author(s):  
Jeffrey A. Cohen ◽  
Justin J. Mowchun ◽  
Victoria H. Lawson ◽  
Nathaniel M. Robbins
Keyword(s):  
Bariatric Surgery ◽  
Peripheral Neuropathy ◽  
Vitamin B12 ◽  
Gastrointestinal Disease ◽  
Vitamin B12 Deficiency ◽  
Vitamin Supplementation ◽  
Common Causes ◽  
B12 Deficiency ◽  
Balance Problems

A number of nutritional causes of peripheral neuropathy have been identified. Patients who have gastrointestinal disease or who have undergone bariatric surgery are at risk, although frequently the specific cause is not ascertained. Vitamin B12 and thiamine deficiencies are the most common causes in bariatric surgery patients. The classic clinical picture of Vitamin B12 deficiency is a myelopathy with a concomitant peripheral neuropathy. Thiamine deficiency is the classic triad of mental status changes, opthalmoplegia, and ataxia. Copper deficiency is often unrecognized. Its presentation can be similar to Vitamin B12 deficiency. It is important that bariatric surgery patients receive continual follow up of their nutritional status and adherence to vitamin supplementation. Alcohol may cause a peripheral neuropathy through nutritional deficiency or perhaps direct toxic effects. Other deficiency states are discussed.

scholarly journals Is Inflammation Status in Postbariatric Patients Predictive for Their Response to Vitamin B12 Supplementation Therapy?

2021 ◽  
Vol 105 (1-3) ◽  
pp. 397-401
Author(s):  
Sjaak Pouwels ◽  
Hendrika J.M. Smelt ◽  
Johannes F. Smulders
Keyword(s):  
Bariatric Surgery ◽  
Vitamin B12 ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Reactive Protein ◽  
Inflammatory Status ◽  
B12 Deficiency ◽  
Injection Regimen ◽  
Vitamin B12 Supplementation

Background Several studies indicate that there is a relationship between vitamin B12 levels and inflammatory status. Some studies showed a significantly correlation between vitamin B12 status and inflammation. The aim of this study is to investigate the influence of inflammatory status on the effect of different vitamin B12 supplementation regimes. Methods We selected patients with a vitamin B12 deficiency based on methylmalonic acid (MMA) levels. A moderate vitamin B12 deficiency was defined as an MMA blood level between ≥300 and 430 nmol/L. In included patients, C-reactive protein (CRP), leukocytes, serum vitamin B12, and MMA levels were measured at baseline and after 6 months of follow-up. Results A total of 63 patients were included, treated with 3, 6, or no intramuscular vitamin B12 injections. In the 6 intramuscular injections group, the presupplementation CRP levels significantly predicted the response in terms of vitamin B12 increase (P = 0.015). Also, there was a significant reduction in CRP levels (P = 0.03) after 6 injections. There was a significant correlation between presupplementation MMA and presupplementation CRP (r = 0.127, P = 0.049). Conclusion This study showed that presupplementation CRP levels significantly predicted the response on 6 intramuscular vitamin B12 injections in patients after bariatric surgery. Second, the 6 intramuscular injection regimen showed a significant reduction in CRP levels. Third, there was a significant correlation between MMA and presupplementation CRP. This might indicate that there is interplay between the vitamin B12 supplementation and inflammatory levels in patients after bariatric surgery.

Chemotherapy-induced peripheral neuropathy (CIPN) and vitamin B12 deficiency

2015 ◽  
Vol 23 (7) ◽  
pp. 1843-1850 ◽  
Author(s):  
Janet M. Schloss ◽  
Maree Colosimo ◽  
Caroline Airey ◽  
Luis Vitetta
Keyword(s):  
Peripheral Neuropathy ◽  
Vitamin B12 ◽  
Vitamin B12 Deficiency ◽  
B12 Deficiency

scholarly journals Management of Peripheral Neuropathy and Cardiovascular Effects in Vitamin B12 Deficiency

2021 ◽  
Vol 10 (5) ◽  
Author(s):  
Nishant Kumar Singh ◽  
Hirni J. Patel ◽  
Mohit Buddhadev ◽  
S P Srinivas Nayak ◽  
Gunosindhu Chakraborthy
Keyword(s):  
Cardiovascular Disease ◽  
Peripheral Neuropathy ◽  
Vitamin B12 ◽  
Peripheral Nerves ◽  
Vitamin B12 Deficiency ◽  
Cardiovascular Effects ◽  
The Elderly ◽  
Vitamin Deficiencies ◽  
B12 Deficiency ◽  
Artery Disease

Peripheral nerves are susceptible to damage by a wide array of toxins, medications, and vitamin deficiencies. Vitamin B12 (VB12) deficiency neuropathy is a rare debilitating disease that affects mostly the elderly. It is important to consider these etiologies when approaching patients with a variety of neuropathic presentations in this review were have included most relevant and latest information on mechanisms causing Peripheral neuropathy in VB12 deficiency. We also have included cardiovascular disorders and their management. Hyperhomocysteinemia has been implicated in endothelial dysfunction and cardiovascular disease. The association of homocysteine (Hcy) and VB12 with cardiovascular risk factors in patients with coronary artery disease (CAD) has also been studied Keywords: Peripheral Neuropathy, Vitamin B12 Deficiency, Cardiovascular Disease and Homocysteine.

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

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.

scholarly journals Evaluation of Nutritional Deficiency-5 Years and More Outcomes Post Laparoscopic Sleeve Gastrectomy

2021 ◽  
Author(s):  
Elif Çırak ◽  
Seda Sancak ◽  
Ali Özdemir ◽  
Aziz Bora Karip ◽  
özgen çeler ◽  
...  
Keyword(s):  
Sleeve Gastrectomy ◽  
Vitamin B12 ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Serum Iron ◽  
Vitamin B12 Deficiency ◽  
Nutritional Deficiencies ◽  
B12 Deficiency ◽  
Compliance To Treatment ◽  
Treatment Of Obesity

Abstract IntroductionNowadays one of the most popular surgical method for treatment of obesity is laparoscopic sleeve gastrectomy (LSG). Data regarding long-term nutritional deficiencies following LSG are scare. We aim to assess the prevalence of nutritional deficiencies 5 years post-LSG.MethodsWe retrospectively reviewed the files of 338 patients who had LSG surgery between June 2012 and June 2019 and had preoperative data and had at least 1 year of surgery. Serum iron, ferritin, folic acid, hemoglobin and vitamin B12 levels during annual visits for six years after LSG were compared with preoperative data. Patients with missing data during follow-up were evaluated as dropout and assessments were made on patients with available data.ResultsA total of 338 patients (83% women), with a baseline BMI 46,87±6,17 kg/m2 were included. In baseline, hypoferritinemia was detected in 19.16% for <15 ng/mL cutoff and in 43.11% for <30 ng/ml cutoff value. Serum iron, vitamin B12 and folate deficiencies were exist in 37.62%, 18.64% and 4.14% of the patients, respectively. We compared this prevalances with postoperative datas and found that ferritin deficiency in follow-up visits was significantly more frequent than the baseline (p<0.001), conversely vitamin B12 deficiency was significantly less common (p<0,05).ConclusionDespite the supplement, our results show that the prevalence of patients with hypoferritinemia after LSG is higher than before surgery. This high prevalence may be associated with factors such as insufficient supplementation, insufficient absorption of oral preparations, and insufficient compliance to treatment.

scholarly journals Profiling immuno-metabolic mediators of vitamin B12 deficiency among metformin-treated type 2 diabetic patients in Ghana

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0249325
Author(s):  
Samuel Asamoah Sakyi ◽  
Edwin Ferguson Laing ◽  
Richard Mantey ◽  
Alexander Kwarteng ◽  
Eddie-Williams Owiredu ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Diabetic Neuropathy ◽  
Vitamin B12 ◽  
Intrinsic Factor ◽  
Vitamin B12 Deficiency ◽  
Anthropometric Measurement ◽  
Diabetic Patients ◽  
Vitamin B ◽  
Tnf Α ◽  
B12 Deficiency

Background The association between prolong metformin usage and B12 deficiency has been documented. However, the prevalence estimates of metformin-induced vitamin B12 deficiency showed substantial disparity among studies due to varied study definitions of vitamin B12 deficiency. Metformin blocks the calcium dependent absorption of the vitamin B12-Intrinsic Factor complex at the terminal ileum. Lack of intrinsic factor due to the presence of auto-antibodies to parietal cells (IFA) could lead to vitamin B12 deficiency and subsequently cause peripheral neuropathy. We investigated the prevalence of vitamin B12 deficiency using more sensitive, combined markers of vitamin B12 status (4cB12) and the immuno-biochemical mediators of vitamin B12 deficiency. Methods In this observational study, 200 consecutive consenting metformin-treated T2DM patients, aged 35 and above, attending the diabetic clinic at KATH were recruited. Vitamin B12 deficiency was classified based on the Fedosov age-normalized wellness quotient. Anthropometric measurement was taken as well as blood samples for immunological and biochemical mediators. Peripheral neuropathy was assessed using the Michigan Neuropathy Screening Instrument (MNSI). Statistical analysis was performed using the R Language for Statistical Computing. Results Using the combined indicator (4cB12), the prevalence of metformin induced vitamin B12 deficiency was 40.5% whilst the prevalence of MNSI-Q and MNSI-PE diabetic neuropathy was 32.5% and 6.5% respectively. Participants with vitamin B12 deficiency had significantly higher levels of IFA, GPA, TNF-α, TC, LDL and albumin compared to those with normal vitamin B12 levels (p < 0.05). Correlation analysis revealed a statistically significant negative association between 4cB12 and the immunological markers [IFA (rs = -0.301, p<0.0001), GPA (rs = -0.244, p = 0.001), TNF-α (rs = -0.242, p = 0.001) and IL-6 (rs = -0.145, p = 0.041)]. Likewise, 4cB12 was negatively associated with TC (rs = -0.203, p = 0.004) and LDL (rs = -0.222, p = 0.002) but positively correlated with HDL (rs = 0.196, p = 0.005). Conclusion Vitamin B12 deficiency and diabetic neuropathy are very high among metformin-treated T2DM patients and it is associated with increased GPA, IFA, TNF-α and cardiometabolic risk factors (higher LDL and TC and lower HDL). Upon verification of these findings in a prospective case-control study, it may be beneficial to include periodic measurement of Vitamin B12 using the more sensitive combined indicators (4cB 12) in the management of patients with T2DM treated with metformin in Ghana.

scholarly journals Methylmalonic acid, vitamin B12, renal function, and risk of all-cause mortality in the general population: results from the prospective Lifelines-MINUTHE study

BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Ineke J. Riphagen ◽  
Isidor Minović ◽  
Dion Groothof ◽  
Adrian Post ◽  
Manfred L. Eggersdorfer ◽  
...  
Keyword(s):  
Renal Function ◽  
Vitamin B12 ◽  
Methylmalonic Acid ◽  
Vitamin B12 Deficiency ◽  
Endogenous Production ◽  
Increased Risk ◽  
B12 Deficiency ◽  
Study Population ◽  
Age And Sex

Abstract Background Methylmalonic acid (MMA) is best known for its use as a functional marker of vitamin B12 deficiency. However, MMA concentrations not only depend on adequate vitamin B12 status, but also relate to renal function and endogenous production of propionic acid. Hence, we aimed to investigate to what extent variation in MMA levels is explained by vitamin B12 and eGFR and whether MMA levels are associated with mortality if vitamin B12 and eGFR are taken into account. Methods A total of 1533 individuals (aged 60–75 years, 50% male) were included from the Lifelines Cohort and Biobank Study. Individuals were included between 2006 and 2013, and the total follow-up time was 8.5 years. Results Median [IQR] age of the study population was 65 [62–69] years, 50% was male. At baseline, median MMA concentration was 170 [138–216] nmol/L, vitamin B12 290 [224–362] pmol/L, and eGFR 84 [74–91] mL/min/1.73 m2. Log2 vitamin B12, log2 eGFR, age, and sex were significantly associated with log2 MMA in multivariable linear regression analyses (model R2 = 0.22). After a total follow-up time of 8.5 years, 72 individuals had died. Log2 MMA levels were significantly associated with mortality (hazard ratio [HR] 1.67 [95% CI 1.25–2.22], P < 0.001). Moreover, we found a significant interaction between MMA and eGFR with respect to mortality (Pinteraction < 0.001). Conclusions Only 22% of variation in MMA levels was explained by vitamin B12, eGFR, age, and sex, indicating that a large part of variation in MMA levels is attributable to other factors (e.g., catabolism, dietary components, or gut microbial production). Higher MMA levels are associated with an increased risk for mortality, independent of vitamin B12, eGFR, and sex. This association was more pronounced in individuals with impaired renal function.

scholarly journals Ileocecal valve syndrome and vitamin b12 deficiency after surgery: a multicentric prospective study

2020 ◽  
Author(s):  
Paola Germani ◽  
Annalisa Zucca ◽  
Fabiola Giudici ◽  
Susanna Terranova ◽  
Marina Troian ◽  
...  
Keyword(s):  
Vitamin B12 ◽  
Vitamin B12 Deficiency ◽  
Ileocecal Valve ◽  
Female Gender ◽  
Right Colectomy ◽  
Bowel Habits ◽  
Intestinal Activity ◽  
B12 Deficiency ◽  
Eortc Qlq

AbstractPatients undergoing colon resection are often concerned about their functional outcomes after surgery. The primary aim of this prospective, multicentric study was to assess the intestinal activity and health-related quality-of-life (HRQL) after ileocecal valve removal. The secondary aim was to evaluate any vitamin B12 deficiency. The study included patients undergoing right colectomy, extended right colectomy and ileocecal resection for either neoplastic or benign disease. Selected items of GIQLI and EORTC QLQ-CR29 questionnaires were used to investigate intestinal activity and HRQL before and after surgery. Blood samples for vitamin B12 level were collected before and during the follow-up period. The empirical rule effect size (ERES) method was used to explain the clinical effect of statistical results. Linear mixed effect (LME) model for longitudinal data was applied to detect the most important parameters affecting the total score. A total of 158 patients were considered. Applying the ERES method, the analysis of both questionnaires showed clinically and statistically significant improvement of HRQL at the end of the follow-up period. Applying the LME model, worsening of HRQL was correlated with female gender and ileum length when using GIQLI questionnaire, and with female gender, open approach, and advanced cancer stage when using the EORTC QLQ-CR29 questionnaire. No significant deficiency in vitamin B12 levels was observed regardless of the length of surgical specimen. In our series, no deterioration of HRQL and no vitamin B12 deficiency were found during the follow-up period. Nevertheless, warning patients about potential changes in bowel habits is mandatory. In our series, no deterioration of HRQL and no vitamin B12 deficiency were found during the follow-up period. Nevertheless, warning patients about potential changes in bowel habits is mandatory.

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

2013 ◽  
Vol 7 (1) ◽  
pp. 44-48 ◽  
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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