, Volume 164, Issue 4, pp 257-258
Date: 20 Jan 2005

Vitamin B12 deficiency presenting as oedema in infants of vegetarian mothers

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We report two cases of nutritional vitamin B12 deficiency in infancy, highlighting the importance of B12 supplementation to vegetarian mothers during pregnancy and breast-feeding.

The first patient, a 9-month-old Caucasian girl, presented with a 3-week history of generalised puffiness. She was born at term to a vegetarian mother. The infant was exclusively breast-fed as she was not interested in solids. Her height and weight were above the 75th percentile and head circumference just below the 75th percentile. She could sit without support and was pale with an expressionless face.

Laboratory investigations demonstrated macrocytic anaemia (haemoglobin 8.3 g/dl, MCV 101.4 fl) and hypoalbuminaemia (23 mg/l). Serum vitamin B12 was low at 49 ng/l (reference range 150–900 ng/l). Ferritin and folate levels were normal. Maternal vitamin B12 level was 185 ng/l. Following intramuscular injections of vitamin B12, her oedema resolved and she became more responsive. Two months later, she had a normal ...