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Peripheral Neuropathy, B12 deficiency

Numb : Part 1

Step 1: View clinicals

A 60 year old man presents with numbness of both feet for 2 months. He was diagnosed with type 2 diabetes mellitus 6 years ago, which is well controlled on Metformin alone. His medical history is otherwise unremarkable. He consumes a mixed diet and only drinks socially. His HbA1c is 6.0%, while a recent full blood count and serum creatinine were normal.

Step 2: Order all relevant investigations

Electrodiagnostic studies

There is a length dependent sensory and motor polyneuropathy.

ESR + S. Electrophoresis

ESR: 10 mm/1h The serum plasma electrophoresis shows a normal pattern.

Serum Vitamin B12 and Folate

Serum Vitamin B12: 95 pg/ml (200 - 900) Serum Folate: 10 ng/ml (5 - 16)

Serum TSH

Serum TSH: 1.0 mIU/L (0.4 - 4)

Step 3: Select appropriate management

Vit-B12 supplementation
Folate supplementation
Protective footwear

Score: ★★☆