tag:blogger.com,1999:blog-11288840.post115738803373537126..comments2024-02-08T05:17:29.432-05:00Comments on Kidney Notes: Nephrology Cases #11: Refractory Orthostatic HypotensionTesthttp://www.blogger.com/profile/17979185526814569632noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-11288840.post-1157446824567388432006-09-05T05:00:00.000-04:002006-09-05T05:00:00.000-04:00Cool. As an electrophysiologist dealing in syncop...Cool. As an electrophysiologist dealing in syncope on a daily basis, this is case is greatly appreciated.DrWeshttps://www.blogger.com/profile/17438019699222125477noreply@blogger.comtag:blogger.com,1999:blog-11288840.post-1157388929260968002006-09-04T12:55:00.000-04:002006-09-04T12:55:00.000-04:00The test was a methylmalonic acid level (which was...The test was a methylmalonic acid level (which was elevated). This is diagnostic of vitamin B12 deficiency, which caused an isolated autonomic neuropathy and orthostatic hyptoension in this patient. Vitamin B12 deficiency was likely related to his previous gastrectomy; it can be difficult to diagnose and can present with a vitamin B12 level in the normal range.<BR/><BR/>The treatment was oral vitamin B12 2000 mcg once daily. His hypotension resolved within one month.<BR/><BR/>Vitamin B12 deficiency can rarely cause an isolated autonomic neuropathy with orthostatic hypotension as the primary symptom.<BR/><BR/><A HREF="http://scholar.google.com/scholar?hl=en&lr=&q=%22vitamin+b12+deficiency%22+%22orthostatic+hypotension%22" REL="nofollow">A Google Scholar search on this topic is here.</A>Testhttps://www.blogger.com/profile/17979185526814569632noreply@blogger.com