### What you need to know
Vitamin B12 (cobalamin) is a water soluble vitamin required for several physiological processes, including normal nervous system functioning, and red blood cell development and maturation. It has antioxidant effects, is a co-factor in mitochondrial energy metabolism, and contributes to DNA synthesis, the methylation cycle, and epigenetic regulation.12 B12 is present in foods of animal origin, such as meat, eggs, and milk, or via food fortification. Healthy adults require an average intake of 4-7 mcg daily to maintain B12 status.34
Treatment with B12 may be required for a variety of reasons (table 1).
View this table:
Table 1
Main indications and administration routes for B12 treatment
Evidence from animal and human studies shows that B12 also has neuroprotective and anti-inflammatory properties,15 and intervention studies in humans have reported beneficial effects of better B12 status or B12 therapy in multiple sclerosis,16 Parkinson’s disease,17 mya
### What you need to know
A 34 year old woman with pulmonary tuberculosis started first-line anti-tuberculosis therapy comprising rifampicin, isoniazid, pyrazinamide, and ethambutol. Two weeks into treatment, she complained of nausea and dark discoloration of urine. Liver enzymes and bilirubin (normal at baseline) were raised, with levels of bilirubin three times above the upper limit of normal, alanine aminotransferase four times above, and alkaline phosphatase two times above. A diagnosis of anti-tuberculosis drug-induced liver injury (DILI) was made, and all her anti-tuberculosis drugs were stopped. Over a period of 10 days, her DILI related symptoms resolved and liver function tests normalised. Ethambutol and isoniazid were then restarted, followed three days later by the addition of rifampicin and, a further three days later, pyrazinamide. No recurrence of DILI was encountered, and the patient completed anti-tuberculosis therapy successfully.
Rifampicin, isoniazid, and pyrazina
Health, Beauty and Lifestyle with Denise McNamara Patricia McGettigan grew up in a house in Inverin where flowers and herb would be used as remedies for common complaints. Once married, she moved first to Donegal and then to the UK and anywhere she set up home she would grow herbs and use those to create […]