Vitamin B12 deficiency: management

Basic investigations

• Vitamin B12: this is low
• Iron level
• Mean corpuscular volume (MCV)
• Blood film appearance
• Parietal cell antibodies
• Schilling test

Vitamin B12 metabolites

Risk factors for low normal vitamin B12 (200-500pg/ml)

Causes of false low vitamin B12 level

Treatment

References

1. Bertorini TE. Neuromuscular Case Studies. Butterworth Heinemann Philadelphia 2008 pp313-316.
2. Solomon LR. Diabetes as a cause of clinically significant functional cobalamin deficiency. Diabetes Care 2011; 34:1077-1080.
3. Hvas AM, Nexo E. Diagnosis and treatment of vitamin B12 deficiency-an update. Haematologica 2006; 91:1506-1512.
4. Overell JR. Peripheral neuropathy: pattern recognition for the pragmatist. Pract Neurol 2011; 11:62-70.
5. England JD, Gronseth GS, Franklin G, et al. Practice Parameter: evaluation of distal symmetric polyneuropathy: role of laboratory and genetic testing (an evidence-based review). Report of the American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and American Academy of Physical Medicine and Rehabilitation. Neurology 2009; 72:185-192.
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Related checklists

• Vitamin B12 deficiency: causes and risk factors
• Vitamin B12 deficiency: clinical features
• Subacute combined degeneration (SCD)
• Cobalamin C disease (cbCD)