A patient joked he had developed a “sixth sense” in his arms and legs – pins & needles parasthesias ! We found him very low on B12 , had been on Metformin and Famotidine for years and years ! An iatrogenic B12 deficiency ? The term Malnutrition applies to both macro and micro-nutrients (vitamins, minerals, co-factors,etc. ). With chronic illnesses on the rise as population gets olders and lives longer with chronic use of medications, it’s important to know nutrient deficiencies induced by long-term use of some common medications.
Some day our EMRs will get super smart and generate immediate intelligent alerts and suggestions based on the problem lists we enter which are automatically queried real-time for causes & association in the context of vitals, meds, labs, imaging reports , etc. cross-referenced with latest literature and also alert of future expected complications scenario. For now, our brains gotta do all the heavy lifting 😁 and remember pertinent info !
Quiz: Choose one of the medications listed under each micronutrient most likely to cause it’s deficiency :
Results
#1. Thiamine
Diuretics – Loop & thiazide – are notorious for peeing away Thiamine!
Read this case report on Diuretic induced beri-beri !
#2. Potassium
Potassium-depleting diuretics will pee away that important potassium !
#3. Thiamine
Metformin is absorbed by the same receptor in the upper GI tract that transports Thiamine. This competition sets up patients for reduced Thiamine absorption.
Read this interest case report on lactic acidosis reversal in a patient on Metformin with Thiamine treatment !
#4. Folic Acid
Estrogen inhibits Folic acid absorption. While it’s common knowledge that pregnant ladies should be taking folic acid, women on oral contraceptives for birth control should also be taking folic acid supplements !
#5. Coenzyme Q10
Some beta-blockers including Metoprolol, propranolol, Timolol have shown to reduce Coenzyme Q10 biosynthesis in our body !
#6. Magnesium
Using PPIs chronically more than a year is associated with magnesium deficiency !
#7. Glutathione
Acetaminophen (Tylenol) is metabolised into toxic NAPQI that is neutralized by Glutathione, as discussed elsewhere on this blog.
Glutathione deficiency has many implications for our health !
