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Tingling Sensation, Iatrogenic - Coggle Diagram
Tingling Sensation
Differential Diagnosis
Vascular
Deep Vein Thrombosis
No observable swelling of lower extremities
Ischemic Stroke
No increase in bp
Neurotoxicity
Heavy Metal Exposure
No history of exposure (student)
Chemotherapy
No history
Metabolic
Diabetes
Normal blood sugar level
Hypocalcemia
No decrease
Hyperthyroidism
No increase in t3 t4
Autoimmune
Systemic Lupus Erythematosus
No fever, joint pain
Rheumatoid Arthritis
No joint pain
Trauma
Non-Iatrogenic
Dislocation
No pain
Edema
Non observable
Infection
Syphilis
No increase of leukocyte
Meningitis
No increase of leukocyte
Neurological
Neuritis
No pain
Malabsorption
Chron's Disease
No abdominal pain
Vitamin B12 Deficiency
Key Words
Tingly Legs
3 Months
23 Years Old
History of Obesity
Female
History of Surgery
Anamnesis
History
Sleeve Gastrectomy 6 Months ago
Obesity (BMI=41)
Illness
Diagnostic Approach
Physical Examination
BMI = 28.125 KG/M²
Bp normal
Heart rate normal
Lab
Peripheral blood smear
Observe Macrocytosis
B12 Serum = 100 pg/ml (200-350)
FBC
MCV = 105 fL
RBC 3.2 million (3.5-5.5)
Blood sugar =125 mg/dl
Iatrogenic
Sleeve Gastrectomy
Learning Issues
Treatment & Management
Lifestyle Modification
Pharmacotherapy
Bmi > 40
Orlistat
B12 Supplement
Prevention & Education
B12 supplement
Healthy lifestyle
Etiology
Lack of Intrinsic Factors
Pathophysiology
Obese (BMI 41kg/m2)
Sleeve Gastrectomy Surgery
Decreased Parietal Cells
Decreased Intrinsic Factors Production
Insufficient B12-IF Complex
Decrease in Vitamin B12 Absorption In Illeum
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Decreased Gastric Acid Secretion
Decreased B12 Release from Dietary Proteins
Vitamin B12 Deficiency
Myelin Synthesis Impairment
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Pernicious Anemia
Decrease in Stomach Volume
Reduced Dietary Intake of Vitamin B12
Weight Loss (BMI 28.1/m2)
Risk Factors
Low Animal Product Diet
Drug Consumption (Sucralfate)
Prognosis
Good as long as patient follows dietary change high in vitamin B12
Vitamin B12 Absorption and Metabloism
Digestive Process
Stomach
B12 released by gastric acid and pepsin.
Binds to Haptocorrin (HC) in gastric fluids.
Duodenum
HC degraded by pancreatic enzymes.
B12 binds to Intrinsic Factor (IF) from gastric parietal cells.
Ileum
B12-IF complex binds to Cubilin receptors in ileum (requires Ca²⁺).
Entered into enterocytes, released via LMBD1 protein.
Circulation & Recycling
Transported as TC-B12 complex in blood.
Reabsorbed via enterohepatic circulation.
Stored in liver for long-term use.
Metabolism
Nerve Damage / Compression During Surgery