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| 3301765210 | Folic acid deficiency | a macrocytic anemia, absorbed through the entire GI track, reduced to folate for DNA synthesis. Requirements increase with accelerated growth (pregnancy) and hemolytic amenia | 0 | |
| 3301768122 | Causes of FAD | accelerated tissue growth decreased absorption (elderly, ETOH) malabsorption (sprue, celiac) | 1 | |
| 3301769406 | Presentation | diarrhea, sore tongue, anorexia, irritability, memory loss, ETOH, scleral icterus, splenomegaly | 2 | |
| 3301772640 | Lab presentation | folic acid MMA (will be normal) H&H (repeat in 2 months s/p treatment) | 3 | |
| 3301774326 | Risks | reheating food, little fresh food, pregnancy, growth spurt, hemolytic anemia, RA | 4 | |
| 3301774327 | Treatment: | Folic acid 0.5-1 (max 5mg/daily)-correct underlying cause | 5 | |
| 3301775803 | Folic acid requirements in preganancy: | additional folic acid 0.4mg/day for 3 months prior to conceptions during pregnancy 0.8-1 mg/day for first trimester. continue through lactation If NT defect in the past: 4 mg daily for 3 months before conception & 12 weeks after Always prescribe it. | 6 | |
| 3313564088 | Folic acid rx in adults | 1mg daily | 7 | |
| 3301860452 | Foods With Folate | lentils; dried beans and peas; dark green vegetables such as broccoli, spinach, collard or turnip greens, okra, and asparagus; and citrus fruit and juice | 8 | |
| 3301777140 | Lactation: | depletes folate, if refrigerated ok up to 3 months (then levels below the recommended daily folate requirement) | 9 | |
| 3301800688 | B12 Deficiency, Why is B12 important | Necessary for brain and neuron health Essential for RBC development, causes atrophy of the stomach, need an intrinsic factor to not develop deficiency | 10 | |
| 3301815398 | Chronic def. can cause | nerve and brain damage that may not be reversible (must be caught in 6 months to reverse) | 11 | |
| 3301815410 | Most common cause | pernicious anemia, but also can be gastrectomy, strict Vegans, alcoholics, and small bowel disease | 12 | |
| 3301798866 | Pernicious anemia | Most common form of B12 deficiency autoimmune DO, intrinsic factor is not produced, limiting B12 absorption. abundant on foods or animal origin | 13 | |
| 3301800689 | Presentation: | low Hct (slow developing), neurological s/s: beg beefy tongue, icterus pallor, pale conjunctiva, glossitis, neuropathy that starts peripherally and moves centrally, difficulty with gross and fine motor skills, decrease reflexes, weak grip, decreased vibratory sensation, abnormal Romberg | 14 | |
| 3301801895 | Complications: | can be permanent unless caught within 6 months reversable--peripheral neuropathy, difficulty with balance, memory changes and oral irritation | 15 | |
| 3301832903 | Those most at risk | Autoimmune, vegan, alcoholic, SBD | 16 | |
| 3301804252 | Labs: | CBC (check electroolytes (k)), B12 Parietal cell antibodies, Intrinsic factor antibodies | 17 | |
| 3301835514 | lab presentation | B12 <200, intrinsic factor antibodies, elevated MMA in urine (methymalonic acid), | 18 | |
| 3301805539 | Treatment: | parenteral form (injection) is preferred due to absorption with intrinsic factor- 100mcg/day IM for 1st week, then week for 1 month and then monthly for life. Oral can be absorbed into Small intestine which may led to treatment failure | 19 | |
| 3301862337 | Foods with B12 | eggs, milk, cheese, milk products, meat, fish, shellfish and poultry. Some soy and rice beverages as well as soy based meat substitutes are fortified with vitamin B12 | 20 |
