- Joined
- Jun 28, 2010
- Messages
- 6,397
- Reaction score
- 15
I might be an M4 now, but I know from the months I spent here as an M2 that the Step 1 forums is where all the smartest people chill. So when an attending mentioned something and I couldn't find an explanation...
We all know that when someone has concurrent B12 and folate deficiencies, you have to replete the B12 first; repleting the folate first might cause the macrocytic anemia to improve while making the neurological damage worse or more permanent. But then my GI attending said it was also important to correct thyroid levels before repleting B12 and folate. I can't seem to figure out why after reading medscape, uptodate, etc. Using google, I found an entirely unscientific site which claimed that because of T4's effects on nutrient uptake, it is important to replete T4 before repleting B12/folate, but I haven't found mention of that anywhere else. Anyone know the answer? Is my attending just crazy?
We all know that when someone has concurrent B12 and folate deficiencies, you have to replete the B12 first; repleting the folate first might cause the macrocytic anemia to improve while making the neurological damage worse or more permanent. But then my GI attending said it was also important to correct thyroid levels before repleting B12 and folate. I can't seem to figure out why after reading medscape, uptodate, etc. Using google, I found an entirely unscientific site which claimed that because of T4's effects on nutrient uptake, it is important to replete T4 before repleting B12/folate, but I haven't found mention of that anywhere else. Anyone know the answer? Is my attending just crazy?