hello i have a 40 year old female patient with chronic fatigue and forgetfullnes who also has hashimatos disease wich is under control. Her serum B12 level vas 164 pg/ml. After treatment with a total of 15 intramuscular doses of 1mg cyanocobalamin each her serum levels only became 174pg/ml.
Her symptoms of fatigue and forgetfullnes continue. She states that she can only make it through the day with constant alarms as reminders of her daily tasks, which indicates significant effects on her overall well functioning.
What could be the reason why her B12 levels doesnt rise despite of treatment. Thank you in advance
Neurologic improvement begins within the first week and is typically complete in 6 weeks to 3 months. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2532799/
The most common cause of vitamin B12 deficiency is inadequate absorption. The following conditions can cause absorption to be inadequate: Overgrowth of bacteria in part of the small intestine. Impaired absorption (malabsorption disorders such as celiac disease or certain pancreatic disorders). https://www.merckmanuals.com/home/disorders-of-nutrition/vitamins/vitamin-b12-deficiency
I have a patient too with pernicious anemia except that she is 2 years old on treatment for more than a year. Developmental milestones are normal but B 12 levels low despite giving optimal parenteral treatment
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