B12 Deficiency and Clinical Presentation in the Setting of Nitric Oxide Use
Table 2
Causes of vitamin B12 deficiency; representation of the exhaustive causes of hypovitaminosis B12 categorized by inactivation, malabsorption, and dietary deficiency.
Inactivation of B12
Malabsorption
Dietary deficiency
Use of nitrous oxide (most commonly in the recreational setting) Nonrecreational use of nitrous oxide anesthesia and underlying subclinical deficiency present
Pernicious anemia Gastrectomy, Gastric bypass, Ileal resection Inflammatory bowel disease, tropical sprue, Crohn disease, Tapeworm infection Transcobalamin II deficiency (inability to transport vitamin B12) Inherited disorders of impaired B12 metabolism Protein-bound vitamin B12 Malabsorption Medications (Metformin, Histamine H2 Blockers, and Proton Pump Inhibitors)
