Food Cobalamin Malabsorption Xn

Numb : Part 2

Step 1: View clinicals

A 60 year old man presented with numbness of both feet for 2 months, and was found to have isolated peripheral neuropathy secondary to underlying vitamin B12 deficiency. He was diagnosed with type 2 diabetes mellitus 6 years ago, which is well controlled on Metformin alone. His medical history is otherwise normal. He takes a mixed diet, and is on no other medications. A full blood count, blood film, iron studies, reticulocyte count and folate levels are all normal.


Step 2: Order all relevant investigations

Anti-IF & Anti-parietal cell Abs

Anti-intrinsic factor antibodies: negative Anti-parietal cell antibodies: negative

Colonoscopy

A colonoscopy will be arranged next week.

INR & Vitamin D

INR: 1.0 (1 - 1.3) Vitamin D: 50 pg/mL (24 - 65)

Anti-endomysial Abs

Anti-endomysial antibodies (IgA): negative


Step 3: Select appropriate management

Gluten Free Diet
Stop Metformin
Vit-B12 Supplementation
Corticosteroids


Score: ★★☆