Vitamin B12

Deficiency
Bustamante, Jon Rubert
Gamutan, Ranillo Jr.
DEFINITION:

A lack of a sufficient amount of vitamin B12

in the body that is needed for optimal
health.
Vitamin B12 deficiency is a common
condition that can result in vitamin B12
deficiency anemia, also known as
pernicious anemia
Possible causes
• Inability of the body to absorb vitamin B12
(Crohn’s disease, ileal resection, gastrectomy)
• Lack of vitamin B12 in the diet (Vegetarian Diet).
• Inability of the cells in the gastric mucosa to
produce instrinsic factor (autoimmune disorder)
• Disease in the ileum and pancreas that impairs
absorption
• Intake of drugs that suppress gastric acid
production (Antiulcer drugs)
Clinical Findings
Due to lack of RBC
Subjective Objective
Due to a lack of  pale skin
red blood cells  shortness of breath
Dizziness  Fatigue
Headache  cold hands and feet
Chest pain  heart palpitations
Due to lack of Vitamin B12
• Subjective • Objective
 numbness and tingling  memory loss
in the hands and feet  dementia
 unsteadiness
 difficulty walking
 confusion
 depression
Effects on GIT
• Subjective • Objective
 nausea  weight loss
 Vomiting  loss of appetite
 abdominal bloating
 gas
 constipation or diarrhea
Laboratory Findings
• CBC
hemoglobin may be low
red blood cells (RBCs) are abnormally large
(macrocytic or megaloblastic)
White blood cells and platelets also may be decreased
level of methylmalonic acid increases
Serum Homocysteine is elevated
• Schilling Test
classic method of determining the cause of the
vitamin B12 deficiency
The patient receives a small oral dose of radioactive
Vit. B12 followed in a few hrs by a large,
nonradioactive parenteral dose of Vit. B12 (which aids
in renal excretion of the radioactive dose)
If oral vitamin is absorbed, more than 8% will be
excreted in the urine
If no radioactivity is present in the urine (the
radioactive Vit. B12 stays within the GI tract)
indicates GI malabsorption of the vitamin B12
if radioactivity is detected in the urine indicates no
ileal disease or pernicious anemia.
• Presence of Intrinsic Factor Binding Antibody
Interferes with B12 binding
• Presence of Intrinsic Factor Blocking
Antibody
A protein that prevents B12 from binding
to intrinsic factor
• Presence of Parietal Cell Antibody
An antibody against the parietal cells that
produce intrinsic factor.
NURSING DIAGNOSIS

Activity intolerance r/t muscle

weakness and decreased strength
Imbalanced Nutrition: less than body
requirements
Risk for injury
Medical Management
• Vit. B12 deficiency is treated by Vit. B12
replacement.
• Oral supplements through vitamins or
fortified soy milk.
• Defective absorption or absence of intrinsic
factor: replacement is by monthly IM
injections of Vit. B12, usually at dose of
1000μg.
Medical Management
(cont.) --reticulocyte count rises within 1 week,
blood counts are all normal. Tongue improves
in several days. Neurologic manifestations
require more time for recovery. If there is
severe neuropathy, patient may never recover
fully.
--to prevent recurrence of pernicious
anemia, Vit. B12 therapy must be continued for
life.
Nursing Management
• Inspection of the skin and mucous
membranes.
• Assess the patient’s gait and stability
and the need for assistive devices to
ensure safety when position sense,
coordination and gait are affected.
Nursing Management
• Advise patient to prepare bland, soft
foods and to eat small amounts
frequently.
• Patient s must also be taught about the
chronicity of their disorder and the
necessity for monthly Vit. B12 injections
even in the absence of symptoms.