Internal Medicine

0521779407-07 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10

580 Folic Acid/Cobalamin (Vitamin B12) Deficiency Folliculitis and Furunculosis

Beware of hyperuricemia and/or hypokalemia∼3–4 days after initi-

ating therapy.

■Nonresponsiveness to cobalamin or folate:

➣Wrong diagnosis

➣Combined folate+cobalamin deficiency treated with 1 vitamin

➣Unrecognized associated disease (iron deficiency, hemoglo-

binopathy, chronic disease, hypothyroidism)

complications and prognosis

■Patients with PA can develop subsequent iron deficiency anemia,

osteoporosis with fractures of the proximal femur and vertebrae, gas-

tric cancer, and cancer of the buccal cavity and pharynx. Posttreat-

ment endoscopic survey to identify early gastric cancer/carcinoids

every∼5 years.

■Indications for prophylaxis with cobalamin/folate

Cobalamin: Vegetarians/vegans (50 mcg/day); post-total gastrec-

tomy w/ achlorhydria (full doses as for PA+iron); in food-cobalamin

malabsorption (i.e., inability to cleave food-cobalamin by acid and

pepsin); patients on long-term therapy (>5 years) with histamine-2

blockers or proton pump inhibitors, replace with cobalamin tablets

(∼100-mcg tablets) per day orally. In all other conditions involving

cobalamin malabsorption, give cobalamin 2,000 mcg/day orally.

➣Folic acid: All women contemplating pregnancy (400 mcg/day),

pregnancy/lactation, premature infants, mothers at risk for sec-

ond neural-tube-defect baby (4 mg/day). For women in the

childbearing age with epilepsy on anticonvulsants (diphenylhy-

dantoin, phenobarbitone, carbamazepine, valproate), give folic

acid 1 mg/day. For patients with hemolytic anemias/hyper-

proliferative states and rheumatoid arthritis/psoriasis being

treated with methotrexate, give folic acid 1 mg/day.

Folliculitis and Furunculosis............................

SHANNON MCALLISTER, MD and JEFFREY P. CALLEN, MD

REVISED BY JEFFREY P. CALLEN, MD

history & physical

■History – Medical problems such as obesity, diabetes mellitus, cor-

ticosteroid use, blood dyscrasia, HIV infection

➣Friction, perspiration, trauma