Cobalamin insufficiency: Clinical manifestations and evidence-based therapeutic interventions

Vitamin B12 also known as cobalamin is one of nine known water-soluble vitamins. It is characterized by its high durability and easy conversion to active cells. In the natural environment, there are two biologically active forms of vitamin B12 (deoxyadenosilobalamin, methylcobalamin).[3] The stable form of Vitamin B 12 cyanobalamin is produced on an industrial scale as an ingredient in pharmaceutical preparations. It has a high strength and is easily converted into active cells: methylobalamin and adenobalamin in the human body.

With adequate intake of meat, the daily requirement for vitamin B12 is supplied even with an excess. Problems related to deficiency can occur in vegans, vegetarians and people with disorders of absorption of this vitamin in the digestive tract. Cobalt reserves are accumulated mainly in the liver and are sufficient for a period of 25 years, so the first symptoms of deficiency appear only after several, including several years of insufficient intake. In the case of autoimmune disease with Addison-Buermian disease or other disorder of digestion, the presence of Bubermian deficiency in the circulatory system may increase after 23 years of age.

Early symptoms of vitamin B12 deficiency are nonspecific. In the early stages of hypothalaminosis, chronic fatigue, weakening of the body, irritability and disturbances of the digestive tract (lack of appetite, nausea, inflammation of the mucous membranes of the oral cavity and tongue). Patients often complain of mood changes and memory problems.

The daily requirement for vitamin B12 is 2.4 μg/d in adults and increases during pregnancy and lactation with a sequence of values: 2.6 μg /d (pregnancy) and 2.8 μg (lactation) [1]. In people over 50 years of age, cobalamin deficiency is often found as a result of insufficient food intake and absorption disorders (most often). However, dietary behaviour may be a contributing factor in the treatment of the symptoms of the disease. In practice, it is based on a diet rich in animal protein, while in people on a supportive diet, the subcutaneous intake of beta-ramethylamine is relatively steady from the beginning of life.

If the causal treatment does not give the desired results, it is a sign that appropriate intervention and substitution therapy should be initiated. If the cause of hypothyroidism is the absence of an internal factor (e.g. in malignant anemia) that hinders or prevents the absorption of vitamin B12 in the traditional way, injections should be administered intravenously at doses determined individually by the doctor, depending on the causes of the deficiency and the results of laboratory tests [5].