Indication: (vitamin B12) deficiency, pernicious anemia, hyperhomocysteinemia
Dosage:
- deficiency: 1000 mcg/day orally, if oral route not adequate, initial treatment is the same as it is for pernicious anemia
- malabsorption: 100 mcg IM or SC for 6-7 days, then give same amount alternating days for 7 days, then every 3-4 days for another 2-3 weeks, then 100 mcg monthly for life
- malabsorption: 1000 mcg IM daily for 10 days or daily for 3-7 days followed by weekly injections for 3-4 weeks
- pernicious anemia: 100 mcg IM or SC daily for 6-7 days, then give same amount alternating days for 7 days, then every 3-4 days for another 2-3 weeks, then 100 mcg monthly for life
- malabsorption: 1000 mcg IM daily for 10 days or daily for 3-7 days followed by weekly injections for 3-4 weeks
Our patient: 1000 mcg/1 mL daily x 7 days SC, then weekly x 4 weeks, then monthly
Counseled patient on:
- how to swab vial, pull back air into syringe, inject vial and draw out correct dose and get rid of air bubbles
- locations for injection: buttocks, arm, side of thigh, and abdomen
- after discussing options with patient, it was decided that the abdomen would be easiest to adminster
- explained rotation of sites and avoiding 2 in circumference around bellybutton
- pinching skin and injecting at 45 degree angle
- avoiding surface veins
- pointing needle bevel in correct angle
- if fluid comes back out of injection site, needle was not into SQ tissue far enough
- how to dispose of needle (Tide container and return to pharmacy)
- injection site reactions
- printed off visual aid on how to do SQ inj.
precautions with inj: anaphylaxis, angioedema
monitoring parameters: hematocrit, reticulocyte count, vitamin b12, folate, iron
absorption: SQ - rapid vs. oral which is slow and variable
distribution: liver and bone marrow
metabolism: biliary, enterohepatic cycling
excretion: renal
vitamin b12 deficiency:
- macrocytic red blood cells
- hypersegmented neutrophils
- pancytopenia
- neurologic symptoms: dementia, weakness, parasthesias
- alcoholics and bariatric surgery at higher risk
- often coexists with folate deficiency
- non-toxic, excreted in urine if excess
levels > 300 pg/mL = normal
200-300 = borderline result
<200 = low/deficient
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