scholarly journals A case of carbamazepine-induced vitamin B12 deficiency and neuropathy

2018 ◽  
Vol 8 (1) ◽  
pp. 166
Author(s):  
Ilathamizhan Jayakumar ◽  
Jayanthi Mathaiyan
Keyword(s):  
Vitamin B12 ◽  
Vitamin B12 Deficiency ◽  
Clonic Seizure ◽  
Tonic Clonic Seizure ◽  
Lower Limbs ◽  
Probability Method ◽  
Drug Induced ◽  
Family History Of Diabetes ◽  
History Of ◽  
B12 Deficiency

Drug induced Neuropathy is seen commonly in patients undergoing treatment with drugs like phenytoin, dapsone, isoniazid etc. Carbamazepine is a drug used in the treatment in the treatment of focal seizure, generalized tonic - clonic seizure and trigeminal neuralgia. It is presented a case of carbamazepine induced vitamin B12 deficiency and neuropathy. A 21 year old male presented to our hospital with complaints of history of slipping of footwear while walking, numbness, impairment of balance and unsteadiness of gait in both lower limbs. Detailed history revealed the patient was on treatment with carbamazepine for tonic - clonic seizure for three months. He is non- smoker, non -alcoholic, not on treatment with other drugs and there is no family history of diabetes mellitus/ sensory neuropathy. On examination power was normal on both lower limbs, vibration sensation was decreased in both lower limbs, sensation was reduced, joint position was affected in bilateral toe and ankle reflex was absent. Vitamin B12 level was found to be 83pg/ml. The patient was discontinued from carbamazepine and started on vitamin B12 therapy and the symptoms subsides slowly. Causality assessment done by WHO- UMC probability method and Naranjo Adverse Drug Reactions Probability Scale showed “Probable” association.

scholarly journals Homocystinuria masquerading as vitamin B12 deficiency

2012 ◽  
Vol 4 (2) ◽  
pp. 326-328
Author(s):  
M Wadhwani ◽  
S Beri ◽  
A Saili ◽  
S Garg
Keyword(s):  
Vitamin B12 ◽  
Megaloblastic Anemia ◽  
Vitamin B12 Deficiency ◽  
Interesting Case ◽  
Vitamin B ◽  
Ophthalmological Examination ◽  
Ophthalmic Manifestations ◽  
History Of ◽  
B12 Deficiency ◽  
Vitamin B 12

Background: Homocystinuria is a rare metabolic disorder charcterised by excess homocysteine in the urine. Vitamin B12 deficiency has diverse cutaneous, nervous and ophthalmic manifestations. Objective: To report a case of homocystinuria masquerading as vitamin B 12 deficiency. Case: We hereby are presenting an interesting case of a 4 year old boy who was being treated for Vitamin B 12 deficiency on the basis of history of delayed milestone, abdominal pain and hyperpigmentation of skin which was diagnosed as homocystinuria. Conclusion: It is important to carry out ophthalmological examination in every case of megaloblastic anemia if associated with blurring of vision and mental retardation.DOI: http://dx.doi.org/10.3126/nepjoph.v4i2.6554 Nepal J Ophthalmol 2012; 4 (8): 326-328

scholarly journals Severe Anaemia during Late Pregnancy

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Mahenaz Akhtar ◽  
Ismail Hassan
Keyword(s):  
Vitamin B12 ◽  
Vitamin B12 Deficiency ◽  
Late Pregnancy ◽  
Severe Anaemia ◽  
Blood Transfusions ◽  
Deficiency Anaemia ◽  
History Of ◽  
B12 Deficiency ◽  
Folate And Vitamin B12 ◽  
In Pregnancy

Vitamin B12 deficiency is uncommon in pregnancy, it occurs in 10–28% of uncomplicated pregnancies, and is associated with a few complications. We present a case report of a 21-year-old patient with severe anaemia during late pregnancy caused by vitamin B12 deficiency. At 38 weeks gestation and with a BMI of 48.9, a history of rupture of membranes was given but not confirmed. On examination, she appeared pale and therefore full blood counts were done. Interestingly her haemoglobin (Hb) levels were 3.7 g/dL. Folate and vitamin B12 levels were also found to be low, and the diagnosis of anaemia caused by vitamin B12 deficiency was made. After treatment with vitamin B12 injections, folic acid and blood transfusions, the patient’s haemoglobin levels improved from 3.7 g/dL to 10.7 g/dL. The conclusion is that effective history taking, diagnosis, and management can prevent many complications that are usually associated with vitamin B12 deficiency anaemia.

scholarly journals A study of aetiology and clinical profile of 50 patients presenting with pancytopenia

2020 ◽  
Vol 7 (4) ◽  
pp. 566
Author(s):  
Janak G. Chokshi ◽  
Bhargavkumar I. Patel ◽  
Ishvarlal M. Parmar ◽  
Dipen R. Damor
Keyword(s):  
Bone Marrow ◽  
Vitamin B12 ◽  
Vitamin B12 Deficiency ◽  
Bone Marrow Examination ◽  
Radiological Imaging ◽  
Peripheral Smear ◽  
Drug Induced ◽  
Presenting Symptoms ◽  
Function Test ◽  
B12 Deficiency

Background: Pancytopenia is reduction of all the three cellular components which includes anemia, leukopenia and thrombocytopenia. Pancytopenia is striking feature of many serious and life threatening illness ranging from simple drug induced bone marrow hypoplasia, megaloblastic marrow to fatal bone marrow aplasia and leukemias. Pancytopenia has variety of etiologies but most common and reversible is Vitamin B12 deficiency, so early and accurate diagnosis may be lifesaving.Methods: Study conducted prospectively in 50 patients of pancytopenia with age >12 years, who were admitted to department of medicine in Dr. M.K. Shah Medical College between 2018 to 2020. A complete clinical history and examination was carried out. They were evaluated for complete blood count with peripheral smear, liver function test, renal function test, vitamin B12 level, radiological imaging and bone marrow examination in selected patients.Results: The etiological causes of pancytopenia were recorded as vitamin B12 deficiency (n 30,60%), Infections (n11,22%),Hypersplenism (n 4;8%), aplastic anemia (n 3; 6%), Drug induced (n 1; 2%) and SLE (n1; 2%). Presenting symptoms in these patients were lethargy, malaise, generalized weakness, dyspnoea on exertion and fever while signs were pallor, splenomegaly and hyperpigmentation. All patients of megaloblastic anemia had macrocytic picture in peripheral smear and all of them were improved after treatment with vitamin B12 supplement.Conclusions: Pancytopenia is not an uncommon clinical entity and has various etiologies. Most common cause of pancytopenia was B12 deficiency and most common symptoms and signs were generalized weakness and pallor respectively. Most of the etiological causes could be diagnosed with laboratory analysis and radiological imaging without the need of a bone marrow examination.

scholarly journals Profile of Vitamin B12 Deficiency and Analysis of Contributory Factors among Inpatients in a Tertiary Care Hospital in Madurai, South India

2020 ◽  
Vol 7 (46) ◽  
pp. 2674-2679
Author(s):  
Vairapraveena Ramesh ◽  
Sangeetha Ashokan ◽  
Anu Sengottaiyan ◽  
Vijay Anto James
Keyword(s):  
Vitamin B12 ◽  
South India ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Vitamin B12 Deficiency ◽  
Cooking Methods ◽  
Care Hospital ◽  
Contributing Factors ◽  
History Of ◽  
B12 Deficiency

BACKGROUND It is well known that Vitamin B12 deficiency is common among vegetarians as Vitamin B12 is obtained predominantly from animal sources. However, recent reports show that Vitamin B12 deficiency is becoming more common among nonvegetarians too and surprisingly the major factor attributing to this is found to be due to dietary deficiency. We hypothesized that this could also be due to the type of non-vegetarian food consumed, cooking methods, type of utensil used, and other modifiable risk factors like smoking, alcohol and diseases causing Vitamin B12 deficiency. We wanted to assess the proportion of vegetarians and nonvegetarians with vit. B12 deficiency and analyse the contributing factors among inpatients with vitamin B12 deficiency in a tertiary care hospital in South India. METHODS This observational, prospective study was done between June and September 2019 & involved 200 Vitamin B12 deficiency patients in the age group of 20 - 50 years of both the genders. Patients were identified after reviewing their medical records and laboratory tests for MCV, MCH, MCHC, Hb & vitamin B12. A detailed history of their food habits, practices & other relevant factors was obtained using a questionnaire. Statistical analysis was done using Mann Whitney U test. RESULTS There was no statistical difference (p = 0.379) in the vitamin B12 levels among vegetarians and non-vegetarians. 54.6 % of participants consumed poultry, 32.5 % consumed fruits & vegetables less than 4 times a week, 36 % & 42 % consumed fried & boiled food, 58 % used ever-silver vessels for cooking, 70.6 % used packaged milk, 23 % consumed alcohol & 21 % were smokers. CONCLUSIONS Vitamin B12 deficiency is common both among vegetarians and non-vegetarians. Among non-vegetarians, deficiency is seen more with poultry eaters, packaged milk consumers, with fried / boiled method of cooking using ever-silver vessels. Alcoholism, caffeinated beverages, smoking, presence of other diseases like diabetes, hypertension, peptic ulcer, drug intake also contributes to Vitamin B12 deficiency. KEYWORDS Vitamin B12 Deficiency, Non-Vegetarians, Vegetarians, Contributing Factors

scholarly journals A Case of Subacute Combined Degeneration of Spinal Cord Diagnosed by Vitamin B12 Administration Lowering Methylmalonic Acid

2020 ◽  
Vol 12 (1) ◽  
pp. 27-34 ◽  
Author(s):  
Daisuke Hara ◽  
Masashi Akamatsu ◽  
Heisuke Mizukami ◽  
Bunta Kato ◽  
Takaaki Suzuki ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Vitamin B12 ◽  
Methylmalonic Acid ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Lower Limbs ◽  
Total Serum ◽  
Subacute Combined Degeneration ◽  
Laboratory Findings ◽  
B12 Deficiency

Subacute combined degeneration of the spinal cord (SCDS) is a neurodegenerative disease characterized by subacute progression in the central and peripheral nervous systems mainly caused by vitamin B12 deficiency. It is known that typical SCDS is frequently accompanied by megaloblastic anemia and increased serum methylmalonic acid (MMA) or homocysteine (Hcy) levels on laboratory findings, and marked abnormalities on spinal cord magnetic resonance imaging (MRI). A 45-year-old woman was admitted to our hospital with a 2-year history of worsening mild weakness, numbness in bilateral lower limbs, and gait disturbance. On admission, as laboratory findings, blood count showed macrocytosis without anemia, and biochemical tests showed mild reduction in total serum vitamin B12 level and no increase of MMA and Hcy levels; there were no abnormal findings on spinal cord MRI. After administration of vitamin B12, her sensorimotor symptoms were improved and laboratory examination showed that macrocytosis was improved, serum vitamin B12 was increased, and serum MMA levels were decreased. This improved clinical course and the laboratory findings following vitamin B12 administration confirmed the diagnosis of SCDS due to vitamin B12 deficiency. SCDS presents with highly variable symptoms and laboratory findings, and observation of MMA levels and neurologic symptoms before and after vitamin B12 administration may be useful for diagnosing SCDS.

Ofloxacin-Lnduced Seizure

1997 ◽  
Vol 31 (12) ◽  
pp. 1475-1477 ◽  
Author(s):  
Gary D Walton ◽  
Jeremy K Hon ◽  
Tejanand G Mulpur
Keyword(s):  
Renal Function ◽  
Clonic Seizure ◽  
Tonic Clonic Seizure ◽  
Structural Defects ◽  
Seizure Threshold ◽  
Multiple Drug ◽  
Drug Induced ◽  
Days Of Therapy ◽  
History Of ◽  
History Of Epilepsy

OBJECTIVE: To describe a possible case of ofloxacin-induced generalized tonic—clonic seizure. Although the etiology is unknown, ofloxacin most likely precipitated this patient's seizure threshold because of sepsis or secondary to drug accumulation due to the patient's compromised renal function. CASE SUMMARY: A 69-year-old white woman with non-small-cell lung cancer and a history of central nervous system metastatic disease treated with radiation therapy presented to the emergency department with symptoms of urosepsis. Because of multiple drug allergies she was started on ofloxacin (hospital formulary quinolone). After 4 days of therapy she developed a generalized tonic—clonic seizure. A computed tomography scan of the head with and without contrast was negative. The ofloxacin was discontinued and aztreonam therapy was started. Phenytoin therapy was instituted and, despite serum concentrations below the conventional therapeutic range, there was no recurrence of seizure. Subsequent discontinuation of phenytoin did not result in a seizure for this patient. DISCUSSION: Seizures induced by the fluoroquinolones are uncommon. The histopathologic features of this phenomenon are currently unknown. In this patient, imaging studies were negative for structural defects, ruling out metastasis as the cause of the seizure. Therefore, an investigation of drug-related causes ensued. The most likely offending agent was ofloxacin. Ofloxacin has been reported in the literature as a cause of seizures in patients with compromised renal function. CONCLUSIONS: This case and other reports indicate that fluoroquinolones, including ofloxacin, may contribute to seizure development in patients with or without a history of epilepsy. Fluoroquinolone therapy should be used with caution in patients with risk factors for the development of drug-induced seizures.

55: The Risk of Vitamin B12 Deficiency is Low after Ileal Orthotopic Bladder Substitution

2004 ◽  
Vol 171 (4S) ◽  
pp. 15-15
Author(s):  
Urs E. Studer ◽  
Richard Aebischer ◽  
Katharina Ochsner ◽  
Werner W. Hochreiter
Keyword(s):  
Vitamin B12 ◽  
Vitamin B12 Deficiency ◽  
B12 Deficiency ◽  
Bladder Substitution
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