Woman, 75, declines from B12 deficiency after feeling foot sensation

Dr Dawn Harper on signs of vitamin B12 and vitamin D deficiency

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Vitamin B12 shores up numerous processes in the body, such as making red blood cells and aiding a healthy nervous system. When the body does not get enough B12, these same processes start to malfunction, which can have destructive consequences. A case study published in the Journal of Hospital Medicine charts the rapid descent of a 75-year-old woman.

A 75-year-old woman with a past medical history of hypothyroidism presented with weakness and the “sensation of large folds of skin” on the bottom of her feet.

The sensation on her feet is telling because B12 deficiency peripheral neuropathy, also known as nerve damage to the extremities.

This can result in tingling or other sensory abnormalities.

Her past medical history is relevant here because patients with both hypothyroidism and vitamin B12 deficiency have similar symptoms.

Physical exam findings included pale eyes, abdominal tenderness, and darkening of the skin on the back of the fingertips and soles, which were also new since the onset of weakness.

The woman also had evidence of haemolysis, which describes the rupture or destruction of red blood cells.

B12 deficiency can bring about the destruction of red blood cells.

With the presumption of B12 deficiency, and given the initial severity of the deficiency, the patient was treated with a regiment of B12 injections.

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“When patients present with severely low levels of B12, intramuscular administration can be considered for rapid improvement of symptoms, although oral administration of high-dose vitamin B12 (1 to 2 mg daily) is just as effective,” wrote the study authors.

Final lab results after discharge confirmed the diagnosis of pernicious anaemia in the patient.

Pernicious anaemia is the most common cause of vitamin B12 deficiency in the UK.

Pernicious is an autoimmune condition whereby your immune system attacks the cells in your stomach that produce the intrinsic factor – a protein the body uses to absorb vitamin B12.

“This vignette describes an uncommon case of B12 deficiency presenting with severe haemolysis and new onset hyperpigmented rash of the palms and soles,” the case study authors concluded.

B12 deficiency – symptoms and how to respond

Vitamin B12 deficiency can cause a wide range of symptoms. These usually develop gradually, but can worsen if the condition goes untreated.

General symptoms include:

  • A pale yellow tinge to your skin
  • A sore and red tongue (glossitis)
  • Mouth ulcers
  • Pins and needles (paraesthesia)
  • Changes in the way that you walk and move around
  • Disturbed vision
  • Irritability
  • Depression
  • Changes in the way you think, feel and behave
  • A decline in your mental abilities, such as memory, understanding and judgement (dementia).

According to the NHS, you should see a GP if you’re experiencing symptoms of vitamin B12 deficiency.

“These conditions can often be diagnosed based on your symptoms and the results of a blood test,” explains the health body.

It’s also important for vitamin B12 deficiency to be diagnosed and treated as soon as possible.

“Although many of the symptoms improve with treatment, some problems caused by the condition can be irreversible if left untreated,” warns the NHS.

How to top up B12

Good sources of vitamin B12 include:

  • Meat
  • Salmon and cod
  • Milk and other dairy products
  • Eggs.

Most people can be easily treated with injections or tablets to replace the missing vitamins.

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