b12 cyanocobalamin

[DrPettans]

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I'm reading in FA that pancreatic insufficiency can lead to malabsorption of fat and fat-soluble vitamins (A, D, E, K) as well as vitamin B12.
Pathoma doesn't mention vit B12 and I wonder if it really decreases it, and if so, why.

PS: FA also states that pancreatic insufficiency decreases HCO3 production, thus decreases pH, and it also decreases elastases in stool.

 

[worldbeater]

I'm reading in FA that pancreatic insufficiency can lead to malabsorption of fat and fat-soluble vitamins (A, D, E, K) as well as vitamin B12.
Pathoma doesn't mention vit B12 and I wonder if it really decreases it, and if so, why.

B12 is a vitamin that acts as a "wanna be" fat soluble vitamin; it has the same properties of a fat soluble vitamin but is actually a long acting water soluble vitamin(UWorld Q). Usually it's presented as a problem with absorption in the ileum, but anything fat related(in this case pancreatic insufficiency), can cause a problems with absorption.

Additional points:
-B12 is needed as a cofactor for homocysteine methyl transferase and methyl malonyl coa mutase
-It causes problems in homocysteniuria (pediatric patient that gets MIs) when homocystiene is trying to go to methionione, it's the cofactor that acts on the intermediate.

 

[DrPettans]

wow, thank you !

 

[CheungBr]

Pancreatic proteases are needed to cleave R-binder from B12, so that B12 can combine with Intrinsic Factor and be absorbed in the ilium