The patient in the case study was a married 57-year-old man with no history of mental illness.
As his filial relationships were strained, he had self-managed his diet for the past five years, consuming only his favourite processed food bought at a convenience store with no consideration of nutritional balance – a significant detail because poor dietary intake can be responsible for B12 deficiency.
He took leave from work due to lower back pain four months before hospitalisation.
Two months before hospitalisation, he experienced numbness in his right hand and presented to the internal medicine department of a hospital, but no abnormalities were detected.
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About 17 days before hospitalisation, he developed difficulty standing, incontinence, and hallucinations.
He presented to the psychiatric department of another hospital after two days of experiencing these symptoms and was diagnosed with depression.
Since his physical symptoms persisted and psychiatric symptoms “worsened”, he was referred to the psychiatric outpatient department 12 days before hospitalisation, the case study states.
The patient’s symptoms of depression were unremarkable, but difficulty standing, incontinence, and hallucinations such as “seeing the form of a middle-aged man” were still present.
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Results of blood analysis and head computed tomography scans were almost within normal limits. But his behaviour became progressively erratic.
Thus, he was referred and admitted to a psychiatric hospital for “examination of organic diseases and with a suspicion of acute and transient psychotic disorder”, the case study states.
During this time, the patient developed severe abdominal pain and black stools and was transported to the emergency department of a university hospital (nine days after admission to psychiatric hospital).
Blood tests indicated anaemia and renal dysfunction. This is significant. Anaemia – where you have fewer red blood cells than normal or you have an abnormally low amount of a substance called haemoglobin in each red blood cell – is primarily responsible for B12 deficiency.
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On day 19 of hospitalisation, his renal function, anaemia, and delirium improved along with his general condition.
“In our patient, the cause of the vitamin B12 deficiency was thought to be a combination of reduced dietary intake due to an imbalanced diet, malabsorption of vitamins due to atrophic gastritis, and enteritis,” the case study authors wrote.
B12 deficiency treatment
Most people can be easily treated with injections or tablets to replace the missing vitamins.
Good sources of vitamin B12 include:
- Salmon and cod
- Milk and other dairy products