THE ORAL ADMINISTRATION OF VITAMIN B12 IN TROPICAL SPRUE

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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.