Vitamin B12 Deficiency -all you need to know

1. The incidence of b12 deficiency increases with age- affects 5 % of adults older than 65

2. Patients can present with neuropsychiatric abnormalities-patients can have cognitive defects due to degeneration of the dorsal and lateral columns of the spinal cord
3. Diagnosis requires a blood test- levels less than 148 pmol/l are diagnostic of deficiency
4. dietary history and medication history should be checked- meds such as
   

   proton pump inhibitors (acid suppressants )cause b12 deficiency and metformin (diabetes med).Diets low in animal products may lead to deficiency

5. Patients with documented b12 deficiency should be treated- Daily high dose b12 – 1000micrograms b12 daily is as effective as IM b12. Monitor concentrations every 3-6 months.

6. Neuropsychiatric symptoms on treatment should resolve within months.