THE ORAL ADMINISTRATION OF VITAMIN B_12 IN TROPICAL SPRUE

Abstract

Ten patients with active tropical sprue received vit. B12 orally. In 3, the vit. B12 was used in combination with normal gastric juice. All were on a special diet low in animal protein. The hematopoietic effect was compared with that of oral folic acid and intramusc. vit. B12. Small single doses of 15-50 [mu]g. of vit. B12 were given to 8 patients. Optimal response was observed in one case given a single oral dose of 50 ug., without gastric juice; 5 showed sub-optimal responses and in 2 none. Larger oral single doses (90-450 [mu]g.) of vit. B12 alone in 4 patients produced a suboptimal response in one, but no response in the other 3; folic acid (15-30 mg. daily) by mouth or 15-50 [mu]g. of B12 intramusc., produced satisfactory hematologic results. Two patients received multiple daily doses of 100-400 [mu]g. of vit. B12 orally. A suboptimal -reticulocyte response was noted in each case when the dose had been increased to 150-200 [mu]g./day for 7 days. In the 1st case, the Hb increased from 35 to 85% and the erythrocyte count from 1.3 to 3 millions/cu. mm. in 16 wks. Glossitis and diarrhea disappeared in 12 wks. In the 2d case the Hb increased from 63 to 72% in 6 wks. Glossitis and diarrhea disappeared. Simultaneous admn. of gastric juice potentiated the hematopoietic effect of the oral vit. B12 in 2 of 3 patients. The 3d case responded to intramusc. vit. B12. In tropical sprue the approx. minimal oral dose of vit. B12 needed to produce an appreciable reticulocytosis and a definite clinical improvement when given alone is 150-200 [mu]g. daily for 2-3 wks. or more. Oral vit. B12 is not recommended in the treatment of tropical sprue. Intramusc. vit. B12 or oral folic acid are more potent.