7/31/2023 0 Comments Free download wonderlands reddit![]() Within the stomach there are several etiologies that degrade the ability of vitamin B 12 to bind with intrinsic factor, including pernicious anemia, atrophic gastritis, prolonged antacid use (proton-pump inhibitor or H2-antagonists), 1 and gastric bypass. A diet containing minimal animal products provides sufficient vitamin B 12, so severe deficiency due to poor intake occurs only in the case of strict veganism. Therefore, in a neuropathy with significant asymmetry, polyradicular, or mononeuritis multiplex presentation, other etiologies should be explored further, even in the setting of documented toxicity or vitamin deficiency.Ĭauses of vitamin B 12 deficiency can be organized by where the absorption defect occurs. ![]() Most toxic and vitamin deficiency–related neuropathies present in a length-dependent fashion with axonal pathology (apart from some notable exceptions detailed below). For example, a patient with more sensory loss on examination than expected from considering his or her history, combined with high arches and hammertoes, may reflect a long-standing hereditary neuropathy that has finally become symptomatic (especially in the setting of a positive family history of neuropathy). It is also important to recognize that other causes of neuropathy may mimic what is suspected to arise from a toxic source or a vitamin deficiency. It is important to take a complete review of systems to determine whether a multisystem syndrome is present as this may lead to a correct diagnosis. ![]() While most forms of malnutrition no longer plague developed societies, a history of gastric surgery, chronic malabsorption, or alcoholism may predict the presence of vitamin deficiencies. In particular, asking about recent changes in exposures may provide useful information, as many of the toxic exposures result from new day-to-day habits. ![]() Careful attention must be paid to occupational and home exposures. As with most types of peripheral neuropathies, acquiring a detailed history is crucial to the diagnosis of neuropathies caused by toxic agents and vitamin deficiencies.
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