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Vitamin B12 Deficiency

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1. Vitamin B12 deficiency

Vitamin B12 deficiency Vitamin B12 deficiency - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Vitamin B12 deficiency Last reviewed: February 2019 Last updated: June 2018 Summary Classically presents with megaloblastic anaemia, but can also present with peripheral neuropathy and neuropsychiatric complaints. Older people, patients with chronic malabsorption, patients with a history of gastric resection or bypass (...) , and those taking certain medicines (metformin, proton-pump inhibitors) are at risk. Early diagnosis is critical in preventing and halting the progression of neurological disorders such as peripheral neuropathy and dementia. Methylmalonic acid and homocysteine levels may help to diagnose vitamin B12 deficiency at an early, asymptomatic state. Cause of vitamin B12 deficiency should be searched for once a diagnosis is confirmed. Treatment with high-dose oral vitamin B12 therapy may be as effective

2018 BMJ Best Practice

4. Active B12 assay for diagnosing vitamin B12 deficiency

Active B12 assay for diagnosing vitamin B12 deficiency Activ Active B12 assa e B12 assay for diagnosing vitamin B12 y for diagnosing vitamin B12 deficiency deficiency Medtech innovation briefing Published: 30 September 2015 nice.org.uk/guidance/mib40 pathways Summary Summary The Abbott ARCHITECT Active-B12 assay is a test for detecting levels of serum holotranscobalamin, which is the metabolically available component of vitamin B12, and can be used as a marker of vitamin B12 deficiency. Four (...) diagnostic test accuracy studies, using different reference standards, reported greater diagnostic accuracy for the Active-B12 assay compared with assays measuring other markers of vitamin B12 deficiency. The assay needs less sample preparation than a total vitamin B12 test and the expected cost is about £3.50 per test including VAT, depending on sample throughput. © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 1

2015 National Institute for Health and Clinical Excellence - Advice

5. Fortification of staple foods with vitamin A for vitamin A deficiency. Full Text available with Trip Pro

Fortification of staple foods with vitamin A for vitamin A deficiency. Vitamin A deficiency is a significant public health problem in many low- and middle-income countries, especially affecting young children, women of reproductive age, and pregnant women. Fortification of staple foods with vitamin A has been used to increase vitamin A consumption among these groups.To assess the effects of fortifying staple foods with vitamin A for reducing vitamin A deficiency and improving health-related (...) the studies were conducted in low- and upper-middle income countries where vitamin A deficiency was a public health issue. One of the included trials did not contribute data to the outcomes of interest.Three trials compared provision of staple foods fortified with vitamin A versus unfortified staple food, five trials compared provision of staple foods fortified with vitamin A plus other micronutrients versus unfortified staple foods, and two trials compared provision of staple foods fortified with vitamin

2019 Cochrane

6. Oral vitamin B<sub>12</sub> versus intramuscular vitamin B<sub>12</sub> for vitamin B<sub>12</sub> deficiency. Full Text available with Trip Pro

Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency. Vitamin B12 deficiency is common, and the incidence increases with age. Most people with vitamin B12 deficiency are treated in primary care with intramuscular (IM) vitamin B12. Doctors may not be prescribing oral vitamin B12 formulations because they may be unaware of this option or have concerns regarding its effectiveness.To assess the effects of oral vitamin B12 versus intramuscular (...) by Cochrane. Our primary outcomes were serum vitamin B12 levels, clinical signs and symptoms of vitamin B12 deficiency, and adverse events. Secondary outcomes were health-related quality of life, acceptability to patients, haemoglobin and mean corpuscular volume, total homocysteine and serum methylmalonic acid levels, and socioeconomic effects. We used GRADE to assess the quality of the evidence for important outcomes. We did not perform meta-analyses due to the small number of included trials

2018 Cochrane

7. How should severe vitamin B12 deficiency in pregnancy be managed?

How should severe vitamin B12 deficiency in pregnancy be managed? How should severe vitamin B12 deficiency in pregnancy be managed? – SPS - Specialist Pharmacy Service – The first stop for professional medicines advice Menu · · Published 13th December 2017, updated 13th December 2017 · UKMi This updated Medicines Q&A evaluates the limited evidence available on the management of severe vitamin B12 deficiency in pregnancy Attachments · Word · 52 KB Regional Medicines Information Manager, London

2017 Specialist Pharmacy Services

8. Prophylactic vitamin K for the prevention of vitamin K deficiency bleeding in preterm neonates. Full Text available with Trip Pro

Prophylactic vitamin K for the prevention of vitamin K deficiency bleeding in preterm neonates. Vitamin K is necessary for the synthesis of coagulation factors. Term infants, especially those who are exclusively breast fed, are deficient in vitamin K and consequently may have vitamin K deficiency bleeding (VKDB). Preterm infants are potentially at greater risk for VKDB because of delayed feeding and subsequent delay in the colonization of their gastrointestinal system with vitamin K producing (...) microflora, as well as immature hepatic and hemostatic function.  OBJECTIVES: To determine the effect of vitamin K prophylaxis in the prevention of vitamin K deficiency bleeding (VKDB) in preterm infants.We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 11), MEDLINE via PubMed (1966 to 5 December 2016), Embase (1980 to 5 December 2016), and CINAHL (1982 to 5 December 2016). We also searched clinical trials databases

2018 Cochrane

9. The association of metformin use with vitamin B12 deficiency and peripheral neuropathy in Saudi individuals with type 2 diabetes mellitus. Full Text available with Trip Pro

The association of metformin use with vitamin B12 deficiency and peripheral neuropathy in Saudi individuals with type 2 diabetes mellitus. To compare the prevalence of vitamin B12 deficiency and peripheral neuropathy between two groups of type 2 diabetes mellitus (T2DM) patients treated with or without metformin, and to determine factors associated with vitamin B12 deficiency therapy and dietary intake of vitamin B12.In this retrospective study, we recruited 412 individuals with T2DM: 319 (...) taking metformin, and 93 non-metformin users. Demographics, dietary assessment for vitamin B12 intakes, and medical history were collected. Participants were assessed for peripheral neuropathy. Blood specimens were collected and checked for serum vitamin B12 levels. The differences between the two groups were analyzed using an independent t-test for continuous data, and the Chi-squared or Fisher's exact test was used for categorical data. The relationship of vitamin B12 deficiency with demographics

2018 PLoS ONE

10. How does vitamin C deficiency result in bleeding?

How does vitamin C deficiency result in bleeding? Chiefs’ Inquiry Corner – 2/10/20 – Clinical Correlations Search Chiefs’ Inquiry Corner – 2/10/20 February 10, 2020 2 min read One of the many manifestations of severe vitamin C deficiency, also known as scurvy, is easy bleeding and bruising. Vitamin C, or ascorbic acid, serves as a cofactor in collagen synthesis. Deficiency leads to impaired collagen formation, which results in vascular fragility. When considering the differential diagnosis

2020 Clinical Correlations

11. Vitamin B3 deficiency

Vitamin B3 deficiency Vitamin B3 deficiency - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Vitamin B3 deficiency Last reviewed: February 2019 Last updated: January 2018 Summary Traditionally caused by consuming a diet mainly composed of corn and maize. Severe deficiency leads to pellagra, which is characterised by dermatitis, dementia, diarrhoea, and eventually death. Lean meat, poultry, fish, and peanuts are rich (...) in vitamin B3 (niacin); milk and eggs are rich sources of tryptophan, the precursor of niacin. Deficiency of vitamins B2 (riboflavin) and/or B6 (pyridoxine) reduces the synthesis of niacin from tryptophan and may lead to secondary vitamin B3 deficiency. Rare in developed countries, although there are still outbreaks in Africa, India, and China, particularly in refugees and displaced people. In developed countries, deficiency is most commonly associated with chronic alcohol abuse, GI malabsorption

2018 BMJ Best Practice

12. Vitamin B1 deficiency

Vitamin B1 deficiency Vitamin B1 deficiency - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Vitamin B1 deficiency Last reviewed: February 2019 Last updated: May 2018 Summary The underlying cause of several clinical syndromes, including Wernicke's encephalopathy, wet beriberi, and dry beriberi, rather than a single clinical condition or diagnosis. Clinical presentation depends on the chronicity of the vitamin B1 (...) (thiamine) deficiency. As signs and symptoms are non-specific, the presence of risk factors raises suspicion of the diagnosis. Risk factors include alcohol dependence, malabsorption, and a diet low in thiamine (e.g., based on polished rice). As there is no rapid diagnostic test for the condition, presumptive treatment should be commenced immediately if vitamin B1 deficiency is suspected. Untreated vitamin B1 deficiency in the form of Wernicke's encephalopathy can result in the need for institutional

2018 BMJ Best Practice

13. Vitamin D deficiency

Vitamin D deficiency Vitamin D deficiency - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Vitamin D deficiency Last reviewed: February 2019 Last updated: July 2018 Summary The most common nutritional deficiency worldwide, characterised by serum 25-hydroxyvitamin D <50 nanomol/L (<20 nanograms/mL). Vitamin D insufficiency is regarded as a serum 25-hydroxyvitamin D level between 52 and 72 nanomol/L (21 and 29 nanograms (...) /mL). Main causes include sun avoidance, using sun protection, increased skin pigmentation, inadequate dietary and supplemental vitamin D intake, malabsorption syndromes, obesity, and medication use. Acquired and inherited disorders that either reduce or prevent the metabolism of 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D also present with biochemical and skeletal abnormalities seen with vitamin D deficiency, but in a more severe form. Most patients are asymptomatic. Severe, prolonged vitamin

2018 BMJ Best Practice

14. Lack of historical evidence to support folic acid exacerbation of the neuropathy caused by vitamin B12 deficiency. Full Text available with Trip Pro

Lack of historical evidence to support folic acid exacerbation of the neuropathy caused by vitamin B12 deficiency. In 1998 a Tolerable Upper Intake Level (UL) for folic acid was established based on case reports from the 1940s suggesting that high-dosage folic acid intake, used to treat patients with pernicious anemia, had the potential to precipitate or speed-up the development of neurological problems. This UL has been employed in the decision-making process used by more than 80 countries (...) medical practice for the treatment of pernicious anemia and with the changes in usage of folic acid preparations, including recommended therapeutic dosage and precautions for its usage surrounding the synthesis of folic acid in 1945 and vitamin B12 in 1948. Folic acid package inserts, early editions of hematology textbooks, and international expert reports provide valuable historical information. The recommended therapeutic daily dosage for folic acid of 5-20 mg was unchanged from 1946 through to 1971

2019 American Journal of Clinical Nutrition

15. Association between metformin dose and vitamin B12 deficiency in patients with type 2 diabetes. Full Text available with Trip Pro

Association between metformin dose and vitamin B12 deficiency in patients with type 2 diabetes. Metformin can cause serum vitamin B12 deficiency, but studies on the influence of its duration and dose are lacking. We investigated vitamin B12 deficiency in patients with type 2 diabetes using metformin, in conjunction with other related factors.This cross-sectional study included 1111 patients with type 2 diabetes who took metformin for at least 6 months. Serum vitamin B12 levels were quantified (...) using a competitive-binding immunoenzymatic assay, and vitamin B12 deficiency was defined as serum B12 <300 pg/mL. Information on metformin use and confounding variables were collected from records or questionnaires and interviews.Serum vitamin B12 deficiency occurred in 22.2% of patients (n = 247). After adjusting for confounders, a 1 mg increase in daily metformin dose was associated with a 0.142 pg/mL decrease in vitamin B12 (P < .001). Compared with a daily dose of <1000 mg, the adjusted odds

2019 Medicine

16. Effect of 8-week oral supplementation with 3-µg cyano-B12 or hydroxo-B12 in a vitamin B12-deficient population. Full Text available with Trip Pro

Effect of 8-week oral supplementation with 3-µg cyano-B12 or hydroxo-B12 in a vitamin B12-deficient population. We compare the effect of 8-week oral supplementation with cyano-B12 (currently used in vitamin pills) and hydroxo-B12 (predominant form in the diet) in a population with nutritional vitamin B12 deficiency.Fifty-one healthy Indian adults with baseline serum cobalamin < 200 pmol/L were supplied for 8 weeks with daily oral supplements of 3-µg cyano-B12 (n = 15), 3-µg hydroxo-B12 (n = 16 (...) with cyano-B12 showed a higher increase in total serum cobalamin than the group treated with hydroxo-B12, while other biomarkers changed comparably in the two groups. After 8 weeks of treatment, the biomarker values of the supplemented groups (pooled) differed significantly from the placebo group. Yet, the vitamin B12 status was still poor [cobalamin: 168 (87-302) pmol/L; holotranscobalamin: 19 (8-45) pmol/L; methylmalonic acid: 0.7 (0.2-1.7) µmol/L; homocysteine: 17.2 (2.6-96.8) µmol/L; 4cB12 = - 1.34

2017 European journal of nutrition

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