Self injecting and Hypokalaemia

[Sophieelizabeth]

Hello!

I self inject weekly, but have come across a B12 group on Facebook which states that self injectors should be cautious due to Hypokalaemia.

Does anyone have information on this?

Thank you!

[Gambit62 Administrator]

If you have macrocytic anaemia there is a risk of low potassium whilst new healthy red blood cells are formed. Other than that there is no risk of hypokalaemia associated with B12 - certainly no reason why someone who has been injecting every other day for more than a few months (so macrocytic anaemia should have cleared) needs to worry about it.

However, as B12 absorption problems are often associated with more general absorption issues (eg because of lower stomach acidity) some people can find that other deficiencies can occur - most common are folate and iron

[Ashweb901 in reply to Gambit62]

So I *should* be able to clear my macrocytosis? For 25 years, even with weekly shots for 6-8 weeks and then monthly shots, then sublingual instead of shots, I have always always had big RBCs around 104-105 in MCV. Maybe I will try more frequent shots? My "only" noticeable symptom this year was achy teeth and irritated gums. (Plus my white cells started being low because maybe they were jealous of the red cells getting all the attention.) Eating prunes and bananas now that you say this about potassium....thank you, Gambit!

[Foggyme Administrator in reply to Ashweb901]

Ashweb901.

First, Gambit is quite right about hypokalaemia (low potassium) as it pertains to B12 deficiency: this is only a potential problem when treatment with B12 injections first commences...and then only in the presence of macrocytosis if...and this is the important bit where you’re concerned...if that macrocytosis is caused be B12/folate deficiency. Treatment with B12 injections (and/or folic acid) address the macrocytosis quite quickly (within the first few weeks - after the initial burst of new red cell production), so if you have macrocytosis, it is unlikely that this is now due to B12 deficiency.

Having read some of your previous posts it’s possible to see that your long-term continuing macrocytosis may have roots in an underlying or previous medical condition (or be present as a consequence of previous medical treatment). Haven't got time to detail right now so I've left you some links with further information below).

Hypothyroidism or alcohol intake (even at relatively low levels) can also cause macrocytosis without anaemia.

It's also possible that and MCV of 104-105 is now 'normal' for you (reference ranges are broad and being just over the top or just under the bottom can be normal for some people). This is present in about 10% of people (if I recall correctly) and is called called benign macrocytosis because it exists without anaemia being present (hence, benign, because it has no effect on the body).

Here's some more information about unexplained raised MCV levels:

bloodjournal.org/content/11...

And here's some information about macrocytosis without Anaemia:

gponline.com/macrocytosis/a...

NB: Macrocytosis without anaemia has no effect on potassium levels (since there are no anaemic blood cells to repair and hence no intermediate requirement for additional potassium to repair the red blood cells).

As to the low white blood cells...can be due to a virus, use of antibiotics, severe infections...or a number of other things (some of which may be relevant to your past medical history). Here's more information about that:

mayoclinic.org/symptoms/low...

In view of your past medical history, I'm assuming that your GP is monitoring your blood results?

Might be worth checking out the symptoms of low potassium via an internet search and if you do have symptoms, then ask your GP to check your potassium levels: if you do have low potassium this is highly unlikely to be anything to do with B12 deficiency and would need to be investigated (and perhaps treated by your GP (rather than diet) if your levels are extremely low).

Sophieelizabeth ...what Gambit says, and...some of the B12 Facebook groups are not always as accurate as they can be in terms of the information and advice they give (I.e. we hear here that some advocate 5mg daily doses of folic acid for those inject B12 regularly. This is far too much and recent research indicates that over-supplementation and the consequential high levels of folate in the body may be neuro-toxic and potentially cause irreversible neurological damage). So, always best to double check any advice give.

👍

[Ashweb901 in reply to Foggyme]

Oh gosh I wasn't being critical of gambit at all!! I keep asking doctors, "hey, shouldn't I be able to get my RBCs back in order" with supplementation? They all shrug. So I was taking Gambit as an authority on the matter.

I will take in all the info you provided too, and I'm headed to Cleveland Clinic to see a hematologist more versed in these matters because I had breast cancer last year so my white cells need to straighten up and fly right if I'm gonna be healthy going forward (i had zero chemo, no radiation, but if i ever need it I'm not ready with enough white cells). I gotta be able to repair my DNA.

[Ashweb901 in reply to Foggyme]

And I do have hypothyroid. I tend toward iron anemia without supplementation, ever since I was about 12. Even after having my uterus removed. I even had low iron stores of 20 several years back despite being a meat-eater. The retired hematologist I contacted (when I saw his research study about the role of folate, b12 and iron in blood cell formation) said it could be some yet-undetected congenital "defect" like diamond blackfan anemia.....

Whatever the case, I wouldn't be so persistent except that I had breast cancer and I'd rather be in a better position red and white blood cell wise going forward if i can.

[Sophieelizabeth in reply to Foggyme]

Thank you for your advice, I did think it seemed strange that I hadn’t come across this before

[Sophieelizabeth in reply to Gambit62]

Thank you for your reply, I did think it can’t be that bad if none of us have had any adverse reactions! Xxx

[onyx33]

In 2012 after years of annual B12 Blood Tests due to auto antibodies found previously, I began the usual regime of treatment, I developed hypokalaemia, I didn't know at the time this could be related to treatment for PA and I don't think the GP who phoned about the result of the blood test did either, he asked me if I had been taking anything, the only thing I could think of that could possibly cause this was liquorice tea, which I had been drinking now I wonder if it was related to beginning treatment, it hasn't occured again.