r.g. verma
TRANSCRIPT
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Assignment onAssignment on
Cobalt DeficiencyCobalt Deficiency
VCMVCM--512512
SUBMITTEDTOSUBMITTEDTO--
DR.H.K.MEHTA SIDR.H.K.MEHTA SIRR
SUBMITTED BY-
R.G.VERMA
ROLL NO.- 2809
BATCH- A
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Vitamin B12 isVitamin B12 is
Also known as cobalaminAlso known as cobalamin
Related to blood deficiency diseasesRelated to blood deficiency diseases
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What does it do?What does it do?
Manufactures red blood cells (RBC)Manufactures red blood cells (RBC)
Aids in tissue growthAids in tissue growth
Allows body to use certain nutrientsAllows body to use certain nutrients
Facilitates numerous chemical reactionsFacilitates numerous chemical reactions
Animals body normally containsAnimals body normally contains
50005000--10 00010 000g vitamin B12g vitamin B12
A healthy animal needs 3A healthy animal needs 3--55g per dayg per day
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Which Foods are rich in B12?Which Foods are rich in B12?
Animal products (meat, fish, poultry)Animal products (meat, fish, poultry)
Not usually denatured by cookingNot usually denatured by cooking
Great sources: liver, kidneyGreat sources: liver, kidney
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High Risk DietsHigh Risk Diets
Some nutrients only occur in animalSome nutrients only occur in animalproductsproducts
Major concern is that B12 comes fromMajor concern is that B12 comes frombacteria (which is only found in meatbacteria (which is only found in meat
products)products)
Restricting diet makes it difficult to get allRestricting diet makes it difficult to get all
nutrientsnutrients
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Other CausesOther Causes
Low intestinal B12 uptakeLow intestinal B12 uptake
Low intrinsic factor in the stomachLow intrinsic factor in the stomach
Deficiency ofHCl in gastric juicesDeficiency ofHCl in gastric juices
LaxativesLaxatives
Low uptake in CNSLow uptake in CNS
Lack of calciumLack of calcium
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Consequences of Deficiency:Consequences of Deficiency:
a variety of conditions may occur:a variety of conditions may occur:
anemiaanemia
FatigueFatigue Nerve damagedNerve damaged
Smooth tongueSmooth tongue
Sensitive skinSensitive skin
Loss of memory, exhaustion, loss of muscleLoss of memory, exhaustion, loss of muscle
strengthstrength
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Folic AcidFolic Acid
Can mask B12Can mask B12
deficiencydeficiency
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B12 and SleepB12 and Sleep
Can help those with sleep disordersCan help those with sleep disorders
Releases Melatonin (sleep hormone)Releases Melatonin (sleep hormone)
Works in presence of sunlig
ht and is
Works in presence of sunlig
ht and isbeneficial to jetlagbeneficial to jetlag
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DiagnosisDiagnosis
SerumSerum BB1212 levels are often low in Blevels are often low in B1212 deficiency,deficiency,
but if other features of Bbut if other features of B1212 deficiency are presentdeficiency are present
with normal Bwith normal B1212 then the diagnosis must not bethen the diagnosis must not be
discounted. One possible explanation for normaldiscounted. One possible explanation for normalBB1212 levels in Blevels in B1212 deficiency is antibody interferencedeficiency is antibody interference
in people withhighin people withhigh titrestitres ofofintrinsic factorintrinsic factor
antibodyantibody.. Some researchers propose that theSome researchers propose that the
current standard norms of vitamin Bcurrent standard norms of vitamin B1212 levels arelevels are
too low.too low. In Japan, the lowest acceptable level forIn Japan, the lowest acceptable level for
vitamin Bvitamin B1212 in blood has been raised from aboutin blood has been raised from about
200 pg/ml (145200 pg/ml (145 pMpM) to 550 pg/ml (400) to 550 pg/ml (400 pMpM).).[[
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There is confusion in units of BThere is confusion in units of B1212 deficiencydeficiency
when given by various labs in variouswhen given by various labs in variouscountries.Where units are presented ascountries.Where units are presented as
pg/liter, or pg/L, they are likely in error.pg/liter, or pg/L, they are likely in error.[[citationcitation
neededneeded]]Where they are presented as pg/Where they are presented as pg/mLmL
oror pmolpmol/L, they are likely correct. The/L, they are likely correct. The
ranges for these two units are similar, sinceranges for these two units are similar, since
the molecular weight of Bthe molecular weight of B1212 is approximatelyis approximately
1000, the difference between1000, the difference between mLmL and L.and L.Thus: 550 pg/Thus: 550 pg/mLmL = 400= 400 pmolpmol/L.s/L.s
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SerumSerum HomocysteineHomocysteine andand MethylmalonicMethylmalonic acidacid
levels are considered more reliable indicators oflevels are considered more reliable indicators of
BB1212 deficiency than the concentration of Bdeficiency than the concentration of B1212 ininblood, see for example research at theblood, see for example research at the St. LouisSt. Louis
UniversityUniversity..[29][29] The levels of these substances areThe levels of these substances are
high in Bhigh in B1212 deficiency and can be helpful if thedeficiency and can be helpful if the
diagnosis is unclear. Approximately 10% ofdiagnosis is unclear. Approximately 10% ofpatients with vitamin Bpatients with vitamin B1212 levels between 200levels between 200
400pg/l will have a vitamin B400pg/l will have a vitamin B1212 deficiency on thedeficiency on the
basis of elevated levelsbasis of elevated levels
ofofhomocysteinehomocysteine andand methylmalonicmethylmalonic acidacid..[[citationcitationneededneeded
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Routine monitoring ofRoutine monitoring ofmethylmalonicmethylmalonic acidacid levels inlevels in
urine is an option for people who may not beurine is an option for people who may not be
getting enough dietary Bgetting enough dietary B1212, as a rise, as a rise
ininmethylmalonicmethylmalonic acidacid levels may be an earlylevels may be an early
indication of deficiency.indication of deficiency.[30][30]
If nervous system damage is suspected,If nervous system damage is suspected,BB1212 analysis inanalysis in cerebrospinal fluidcerebrospinal fluid can also becan also be
helpful, though such an invasive test would behelpful, though such an invasive test would be
applicable only after unrevealing blood testing.applicable only after unrevealing blood testing.[31][31]
TheThe Schilling testSchilling test can play a role in the diagnosis.can play a role in the diagnosis.
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TreatmentsTreatments
Oral supplementsOral supplements low success ratelow success rate
Intramuscularly proven more successfulIntramuscularly proven more successful
Active form is most successfulActive form is most successful Must be supplied with folic acidMust be supplied with folic acid
Fish should be emphasized in dietFish should be emphasized in diet
6 months6 months one year to recoverone year to recover
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Vitamin BVitamin B1212 can be given as intramuscular orcan be given as intramuscular or
subcutaneous injectionssubcutaneous injections
ofofhydroxycobalaminhydroxycobalamin,, methylcobalaminmethylcobalamin,,
ororcyanocobalamincyanocobalamin. Body stores (in the liver) are. Body stores (in the liver) are
partlypartly repletedrepleted withhalf a dozen injections in thewithhalf a dozen injections in the
first couple of weeks (full repletion of liver storesfirst couple of weeks (full repletion of liver stores
requires about 20 injections) and thenrequires about 20 injections) and then
maintenance with monthly injections throughoutmaintenance with monthly injections throughout
the life of thethe life of the patientpatient. Vitamin B. Vitamin B1212 can also becan also be
easily selfeasily self--administered by injection by the patient,administered by injection by the patient,
using the same fineusing the same fine--gauge needles and syringesgauge needles and syringes
used for selfused for self--administration ofadministration ofinsulininsulin..
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