Vitamin B12 deficiency in a patient with total gastrectomy.

ABSTRACT

A 31-year-old female was admitted to the hospital with a history of weight loss, weakness and exertional dyspnoea lasting for three months. Four years prior to admission, she had consumed half a glass of cleaning solution and had been admitted to hospital for a total gastrectomy. Physical examination showed markedly pale, cachexia and generalized muscle wasting. Oedema of both legs and hepatomegaly about 2 FB were noted. No abnormal neurologica,l findings were detected. Her blood picture and bone marrow showed megaloblastic changes. Serum vitamin B12 was low but serum and red-cell folate levels were within normal limits. Vitamin B12 (1 mg) was given intramuscularly and it produced a remarkable improvement in the clinical and haematological findings. The patient was discharged nine days after admission and attended the out-patient clinic where she received 1 mg of vitamin B12 intramuscularly once a month. The patient is now healthy with normal haematological findings, but she still receives vitamin B12 therapy monthly.