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  • B12 Deficiency in Breast Fed Infant of Vegetarian 198-4k 1979

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    IG
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    B12 Deficiency in Breast Fed Infant of Vegetarian 198-4k 1979

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    B12 Deficiency in Breast Fed Infant of Vegetarian 198-4k 1979

    Direitos autorais:

    © All Rights Reserved
    Baixe no formato PDF ou leia online no Scribd
    Sinalizar o conteúdo como inadequado
    5 visualizações3 páginas

    B12 Deficiency in Breast Fed Infant of Vegetarian 198-4k 1979

    Enviado por

    IG
    B12 Deficiency in Breast Fed Infant of Vegetarian 198-4k 1979

    Direitos autorais:

    © All Rights Reserved
    Baixe no formato PDF ou leia online no Scribd
    Sinalizar o conteúdo como inadequado
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    “= CLINICAL NUTRITION CASES VITAMIN B12 DEFICIENCY IN THE BREAST-FED INFANT Vitamin B12 deticiency is thought to be rare in children. The megaloblastic anemia of infancy in Western cc untries is'commonly associated with ‘clic acid deficiency.* but in India it has been reportes to bg paused by congenita vita- min ® » deficienc{27ne mothers ofthe vitamin Biz-deticientintants described were stricivege- taria..s who tea reir offspring exclusively on breast milk. On this vitamin Bre-deticient diet, most of the mothers had mild anemia, megalo- blastic bone mrrows and depressed values of vitamin 82 in both plasma and milk. The infants presented wish a characteristic syndrome which included. in additicr: 0 anemia and megatoblastosis, adequate general nutrition skin pigmentatio:, apathy, retardation and in- voluntary movements.’ All these signs were rapidly corrected by small doses of vitamin Bra. A case of congenital vitamin Biz deficiency in an American infant of a strict vegetarian’ has been reportes recently. by Higginbotiom and coworkers. Methyimalonic aciduria, homo- cystinuria, megaioblastic anemia: and neuro- logic abnormalities were observed this infant Case # 1 sie month-ol¢ male infant was admitted to the Unie versity of Caltoma Mesical Cente. San Diego in coma, Ha nad been Born at term, weighing 3 Kg, the fist child of an’ apparenty healthy: 26-year-old vegan. The ‘other had knowingy eaten n0 arms: produets 0° eight years ard took no supplemental viamins. The infant was fxcivs ly breast fed, He smiled between one snd $id months of age anc appeared to be developing noraaly. {Arfour months of age nis development began to regress as maniasted by lors of head contal, decreased vacall, zaton, lethargy and increased italy Physical examination revealed a pale and flaccid invant who was completly unresponsive evento painful stub “The puls> was 135 pee minute, the resprations 22 per minute. «the bi20s pressure 100 mm Hg by palpavcn. ‘Toe longin was 63 om (50th percentia for age) and ine weight 5.5 kg (ess than te thee percent and atthe Sota Percentile for three months of age). Head circumference 142 NUTRITION REVIEWS VOL. 37:NO, 5 MAY 1979 OF A STRICT VEGETARIAN 2. 41 om (thie poreentie). The optic disks wore pale. ‘Tearo wore scattered ecchymoses over the legs ane but. {cons ncreased c:: mentation was noted over In> dasa ot bot te hands snc the fea, most prominenty «2 te ka. 38. The Baby had no head contro and a poor 398. Gea andonrallexes wore not obta'mable. The iver 2oge we» palpable 2m veiow the rigm costal margin Lazoratory studles revealed a he-ncglobin of 5.4 g por ociiter.ahematocrit of 17 percent ares-ell cus of 163. rmiton par microiter, a wiste-eall count of 3800 par micro Mur. eteuoeyte ecunt ot 0.1 percent anda plate: count (f 5.°90 per microite. A peripheral blood smear showad 1m mactocylosis and some hypersegmentaion ot 1ne estcophils. Bone-viatrow aspiration revealed \ank rmcagsloblaste changes in both the myeloid anc tio ory trois series. Megakaryooyles were decreased in um be: The sedimentation cate. unis, spinal 20 iy 5 Blood glucose. electrolytes ic taste of sm and sce function gave normal resus An electtoer alo: (Fm was markedly aacoemal. ab maritesiod Dy = "umal Dackgroune theta acivily and epioatowm var 9's in * bots temporal regions. Analysis of the urine obtain 40928 mmission demonstrated markecly wevated excretion of rmeinyimalonic 8c6,gicine, meinjctic ace anc homo: cystine. These abnormalities suggestod detective &=tty fof cazymes requiring vitamin Br: cofactor The seu ‘concentration of vlamin B:e was 20:pg per miter (nema 150 to 1000 pg per mikii:| The conconratos of folate was 10 ng per milter (normal, 30 15 ng 98¢ ri tet) and tha a ron 165 9 per decir (normal. &. to 176 ug pet deciliter) and the sen-tinding capac". 177 ug per deciliter (normal 250 to 4:9 yg per decir) ‘Stony afer adm: on respraiay distress developed anc 5g of foe acic a8 given, folowed by transtusion of 501 e¢ Wlogram of packed ead blood cals. Four cays late. a repeat Lone marrow examination showed tia! re Vate2! ofthe megacbiastic abrorraltes. A Schiling wos! (gave normal resis, Vitam Bye was administered ina: musculary ina dose of 1 mg per da, forfour days. ‘The patien began to respond to simul aer the tans: fusca; however, the response to wilamin Bye therapy vas cxaratic. Four days citer the ina! ose he was at ming, responding te visual simul and maintaining nis bod tamperaiure. As he responded, rhythmical witching activity in the nght rand and 2m developed thc: pee ‘Soto despite anticonvulsant therapy, and despite ie tat “Gre was concomitant almost complete reso cle. concephalograpiie abnormalities, Evaleaton of the monet reveaie’ a completely noimal parent Svc nane a ssn a0 hg © al contonter ase Ce sano nomal angel se z nebe woo Degen taking supp women OB en eiduria. h folate intakes) p<) | fant vitamin 81,"eefcielcy|h 2d by pregnancy lle natn ol nfant is said to have had) alngr amr. torderline serum-vitafhin al [Getinte methylmalonic acigifrid sna. Her oreast mika of vitamin 8:2. The seyard) iter.By2 which her:infant deve fly beginning in utero: cylin, MegaoBly log Abnotnates 3 A feast Fed inant of a Wew/'Engl Ji Med 2991p Se AIL Covy, SH. Mudd! I» obs, A. Homs and 8] TH THe leo of Folate and Metnonina Malas fer vee urns ore UE Bice. J Ergard ar ‘ cif8| Retardation, Megaloblastc|Anaer tione Acduia and Abn Reese ee

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