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.