Peripheral neuropathies: The Daily PANCE Blueprint

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Peripheral neuropathies: The Daily PANCE Blueprint

A 50-year-old with a history of type 2 diabetes mellitus on chronic metformin therapy presents to your clinic with fatigue, diarrhea, weakness, lower extremity paresthesia, and ataxia. Her labs reveal macrocytic anemia. Which of the following is the most likely diagnosis?

A. Hemolytic anemia
B. B12 deficiency
C. Iron deficiency anemia
D. Myelodysplastic syndrome
E. Hereditary stomatocytosis

Answer and topic summary

The answer is B. B12 deficiency

This patient has been on chronic metformin therapy, which can lead to B12 deficiency (in about 20% of patients) and also folate deficiency. The metformin-induced B12 deficiency has led to her symptoms and peripheral neuropathy. There are many things that can cause peripheral neuropathy including trauma, metabolic/endocrine issues (diabetes, hypothyroidism), medications, toxins, inflammatory issues (GBS), vascular (prolonged ischemia, vasculitis), and vitamin deficiencies (B12, B6, etc).

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Neurology ⇒ Peripheral Nerve Disorders (PEARLS) ⇒ Peripheral neuropathies

Also covered as part of the Internal Medicine Rotation topic list

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