Vitamin B-12 Deficiency without hematologic abnormality- Pros and Cons

Sometimes a patient may show no sign of anemia with normal MCV yet present with psychiatric signs and symptoms. Would you suspect Vit B-12 Deficiency?

Empiric Vit B-12 administration in patients with clinical symptoms consistent with Vit B-12 deficiency regardless of hematologic and serologic findings.

Consequences of Vit B-12 deficiency:

  • Bipolar disorder: Vit B-12 deficiency can result in a condition indistinguishable from a bipolar disorder
  • Organic Brain syndrome: delirium, confusion, poor memory, impaired cognition
  • Dementia and erroneous diagnosis of Alzheimer disease
  • Mood disorders, depression, catatonia, paranoia, paranoid psychosis, violent behavior
  • Peripheral neuropathy, combined degeneration of anterior and posterior columns of the spinal cord
  • Nutritional deficiencies can cause mood disorders and mental disease.
  • Thousands of these psychiatrically labelled patients simply need nutritional supplementation.
  • Metformin used to treat Type 2 Diabetes Mellitus T2DM causes vit B12 deficiency which causes peripheral neuropathy that can erroneously be mistaken to the diabetic neuropathy. Every patient on metformin should receive Vit B-12 supplementation.
  • Given that the evidence in favor of early and empiric treatment for possible Vit B-12 deficiency is stronger than evidence in favor of allowing Vit B-12 deficiency or dependency to persist with potentially catastrophic outcomes, no scientific argument can be made in favor of failing to diagnose and treat Vit B-12 deficiency.
Reporter Correspondent

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