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CPE-009 · synthetic case B12-FX-11
Metformin for three years, B12 never measured
A screening opportunity.
Purpose: A screening opportunity.
Inputs the engine received
Patient
- Age
- 55 years
- Sex
- Male
Drugs, diet and risk groups
- Months on metformin
- 36 months
What the engine reports
Detected clinical pattern
Screening Opportunity: Measure B12
A higher-risk group or drug exposure with no B12 on file.
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1The ADA standards say periodic B12 measurement should be considered in people on metformin, especially with anemia or neuropathy.
Evidence and rule trace · 1 rules
B12-10Drug exposure that lowers B12
Inputs: metformin 36 months
Drug-associated risk of B12 deficiency.
Evidence
- EV-BSH-2014 · Devalia V, Hamilton MS, Molloy AM; British Committee for Standards in Haematology. Guidelines for the diagnosis and treatment of cobalamin and folate disorders. Br J Haematol. 2014;166(4):496-513.
- EV-STABLER-2013 · Stabler SP. Vitamin B12 deficiency. N Engl J Med. 2013;368(2):149-160.
- EV-ADA-STANDARDS · American Diabetes Association Professional Practice Committee. Standards of Care in Diabetes, section on pharmacologic approaches to glycemic treatment (current edition). Diabetes Care.
Physician adjudication required. Clinical decision support for physician review. This output identifies laboratory patterns and safety considerations. It does not diagnose, find the cause, or select a vitamin product, dose or route. Physician adjudication is required.
Change the values
The same engine, starting from this case. Change any value and watch the pattern and the rule trace react.
Serum B12 level
○ Below 200 pg/mL
Deficiency pattern
○ 200 to 300 pg/mL
Borderline: MMA and homocysteine settle it
○ Above 300 pg/mL
Deficiency unlikely, not excluded
No stage is assigned for the values entered.
Laboratory
- <200
- 200–300
- >300
Patient
Neurologic features
Drugs, diet and risk groups
More b12 cases
B12-FX-01
B12 of 150 pg/mL with macrocytic anemia
A 67-year-old with MCV 108.
B12-FX-02
Borderline B12 with raised MMA
B12 260 and MMA 0.52.
B12-FX-03
Borderline B12 and no confirmatory test
B12 250.
B12-FX-04
Macrocytic anemia, folic acid ordered, no B12
A safety situation.
B12-FX-05
Neuropathy, B12 220 and metformin for five years
Neurologic features with a borderline level.
B12-FX-06
Posterior-column signs and spasticity
A pattern compatible with subacute combined degeneration.
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