B12 deficiency in an 85-year old: hypochlorhydria is likely cause
In an 85-year old man with vitamin B12 deficiency, despite an
apparently good diet, one should suspect malabsorption due to
hypochlorhydria. Stomach acid levels diminish with age, and by 85, the
majority of people are likely to have hypochlorhydria.
Adequate stomach acid is also necessary for absorption of other
nutrients, including calcium. This patient should have bone density
testing, as he is at increased risk of osteoporosis.
Sublingual vitamin B12 tablets/drops/sprays are generally effective
and long-term intramuscular injections are rarely necessary.
Treatment of low stomach acid is with supplements of betaine
hydrochloride/pepsin, taken with meals; these are available from many
nutritional supplement manufacturers.
Rapid Response:
B12 deficiency in an 85-year old: hypochlorhydria is likely cause
In an 85-year old man with vitamin B12 deficiency, despite an
apparently good diet, one should suspect malabsorption due to
hypochlorhydria. Stomach acid levels diminish with age, and by 85, the
majority of people are likely to have hypochlorhydria.
Adequate stomach acid is also necessary for absorption of other
nutrients, including calcium. This patient should have bone density
testing, as he is at increased risk of osteoporosis.
Sublingual vitamin B12 tablets/drops/sprays are generally effective
and long-term intramuscular injections are rarely necessary.
Treatment of low stomach acid is with supplements of betaine
hydrochloride/pepsin, taken with meals; these are available from many
nutritional supplement manufacturers.
Competing interests:
None declared
Competing interests: No competing interests