Deficiency or dementia? Exploring B12 deficiency after urostomy

Abstract

Vitamin B12 deficiency can be misdiagnosed as a variety of other illnesses, and if left untreated can lead to irreversible damage to the brain and nervous system. This article discusses the case of a 70-year-old female with a urostomy, well known to the stoma care department, who shortly after a routine parastomal hernia repair developed severe confusion, immobility and was unable to communicate. Subsequent investigations ruled out a cerebrovascular accident (CVA) and a diagnosis of rapidly progressing vascular dementia was made. An incidental finding of a low vitamin B12 level was identified and treatment commenced. She was transferred to a community hospital and her family were told to 'prepare for the worst'. It was, in fact, the vitamin B12 deficiency that was causing her symptoms of vascular dementia, and once treatment was established she underwent a 'miraculous' improvement, returning to normal life. This article discusses vitamin B12 deficiency and why patients with a urostomy are at risk of developing it; highlights the key role of the stoma care nurse and his or her knowledge of the patient; explores the importance of testing vitamin B12 levels in this group of patients; and discusses key learning and recommendations for practice.

Hemoglobin, Albumin, Lymphocyte, and Platelet Count is a Significant Biomarker Surrogate for Nutritional Status to Predict Overall Survival in Patients Post–radical Cystectomy

“…11 Furthermore, use of the terminal ileum during urinary diversion hinders bile acid and vitamin B12 absorption, which has been shown to induce megaloblastic anemia years after surgery. 12…”

“…11 Furthermore, use of the terminal ileum during urinary diversion hinders bile acid and vitamin B12 absorption, which has been shown to induce megaloblastic anemia years after surgery. 12 A routine screening tool for identifying patients who are malnourished or are at risk of malnourishment has been lacking so far in urologic oncology. 6 Various prognostic biomarkers have been proposed as surrogates for immunological and nutritional status to help predict postoperative outcomes.…”

Lack of Clinical Evidence Regarding the Guidelines for Vitamin B12 Deficiency: An Analysis From Literature and Recommendations From Clinical Practice

“…33 -36 Health care professionals sometimes need to remember to consider B12 deficiency in the differential diagnosis, resulting in prolonged investigations and misdiagnosis. 37 -43 Failure to use and inaccessibility of second-line tests, such as the metabolites MMA and homocysteine. These tests are essential in diagnosing B12 deficiency when blood levels of B12 are low-normal to normal.…”

“…Health care professionals sometimes need to remember to consider B12 deficiency in the differential diagnosis, resulting in prolonged investigations and misdiagnosis. 37 -43…”