VITAMIN B12 DEFICIENCY: LIKE HOT PIZZA TO THE TONGUE LEVEL II
Jon P. Wietholter
CASE SUMMARY
A 45-year-old woman presents with complaints of tongue pain, fatigue, paresthesias, anorexia, and early satiety. These complaints have been bothering her over the course of months to years, but she has recently noticed increased tongue swelling and pain. The physical exam and laboratory tests reveal findings consistent with vitamin B12 deficiency, including low hemoglobin, hematocrit, and vitamin B12 levels; elevated MCV and MCH; a low-grade fever; mild tachycardia; mild splenomegaly; and decreased pinprick, vibratory, and temperature sensations in the lower extremities. The peripheral blood smear showed abnormalities commonly seen in vitamin B12 deficiency. Additionally, she is taking both metformin and omeprazole, which are potential causes of vitamin B12 deficiency. Several options for replacement of vitamin B12 are available, and intramuscular (IM), deep subcutaneous (SC), and oral replacement are all potential options for this patient.
QUESTIONS Collect Information 1.a.What subjective and objective information indicates the presence of vitamin B12 deficiency? Complaints of fatigue and lethargy1 (+) red, smooth, swollen, sore tongue with loss of papillae (atrophic glossitis)2 (+) tingling and numbness in feet (paresthesias) and decreased pinprick, vibratory, and temperature sensations in both lower extremities2 Decreased hemoglobin, hematocrit, and RBC count
