Timing Baseline Marker Vitamin B12 and methylmalonic acid Why it matters Helps evaluate B12 status when fatigue, neuropathy, or heavy B-vitamin use is part of the context
may cause iron-deficiency anemia Nausea and vomiting particularly with stricturing disease/obstruction Urgency and tenesmus with rectal/colonic involvement Weight loss and malnutrition due to malabsorption, food avoidance, elevated metabolic demand Fever with active inflammation, abscess, or fistula Perianal disease fissures, fistulae, skin tags, abscesses Extraintestinal Manifestations Arthropathy peripheral or axial (enteropathic arthritis, M07.6x) Dermatologic: Erythema nodosum (L52), pyoderma gangrenosum, psoriasis (L40.5) Ocular: Uveitis/iritis (H20.01), episcleritis, scleritis Hepatobiliary: Primary sclerosing cholangitis (K73.2), fatty liver, cholelithiasis Metabolic: Osteopenia/osteoporosis (from steroid use and malabsorption), nephrolithiasis Hematologic: Anemia (iron deficiency, B12/folate deficiency, anemia of chronic disease) When a patient with Crohns disease is admitted with significant weight loss, malnutrition, or protein-calorie deficiency , query the provider to specify the degree of malnutrition (mild, moderate, severe protein-calorie malnutrition)
Consider supplementation when the patient has risk factors associated with B 12 Deficiency as described in see Table 1: Patient Risk Factors Associated with B 12 Deficiency above
Shelf life: 18 months from manufacture date when stored properly
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