vitamin b12||deficency||diagnosis||managment

VITAMIN B12  or cyanocobalamin

*Vitamin B 12 is essential for normal haemopoiesis and maintenance of normal integrity of 

the nervous system.

*Vitamin B 12  belongs to the family of cobalamins. It is found only in trace amounts in tissues.

*The main sources of vitamin B 12 are animal proteins and dairy products.

*Vitamin B 12 is stored in the liver

*Normal daily requirement of vitamin B 12 is 1-2 μg.

 DEFICENCY OF VIT B12

    **Haemopoietic

• General symptoms and signs of anaemia

• Pallor of skin and mucous membranes

• Megaloblastic macrocytic anaemia

• Pancytopenia

• Splenomegaly

**neurological

• Paraesthesia of fingers and toes from peripheral neuropathy

• Signs of subacute combined degeneration of the spinal cord

• Dementia, depression, irritablity

or

*Glossitis, skin hyperpigmentation

• Intermittent soreness of tongue

• Smooth atrophic tongue

• Raw and red tongue during attacks of glossitis

• Periodic diarrhoea

Diagnosis

• Macrocytic anaemia.

• Hypersegmented neutrophils in peripheral smear.

• Pancytopenia. Myelodysplastic syndrome (MDS) and aplastic anaemia may also present with macrocytosis

Schilling test 

Elevated serum methylmalonic acid (MMA)

treatment

Vitamin B 12 therapy 

 Initial dose of hydroxocobalamin is 1000 μg, deep intramuscularly daily for 1 week

Maintenance dose is 1000 μg of hydroxocobalamin intramuscularly once in a month

Iron therapy with ferrous sulphate 200 mg thrice daily orally should be started 

chronic bronchitis||grade||managment

CHRONIC BRONCHITIS

defination--Chronic bronchitis is defined as a condition associated with excessive tracheobronchial mucus production to cause cough with expectoration for at least 3 months of the year, for more than 2 consecutive years

Grade 0 Gets breathless only on  exercise

Grade 1 Gets breathless walking up a slight hill

Grade 2  Walks slower than people of same age on the level because of breathlessness

Grade 3 Stops for breath after walking 100 meters

Grade 4 Too breathless to leave the house 

managment

Regular exercises 

 nutritional management.

Weight loss in obese patients.

Reduction of bronchial irritation:

Stop smoking completely

Bronchodilator and steroid therapy

Inhalation of 13radrenoreceptor agonists 

Anticholinergic bronchodilator drugs

Oral theophylline or doxophylline