Reference no: EM132943309

Question - A 58-year-old woman presents to the emergency department with progressive fatigue and weakness for the past 6 months. She is short of breath after walking several blocks. On review of systems, she mentions mild diarrhea. She has noted intermittent numbness and tingling of her lower extremities and a loss of balance while walking. She denies other neurologic or cardiac symptoms and has no history of black or bloody stools or other blood loss. On physical examination, she is tachycardic to 110 bpm; other vital signs are within normal limits. The head and-neck examination is notable for pale conjunctivas and a beefy red tongue with loss of papillae. Cardiac examination shows a rapid, regular rhythm with a grade 2/6 systolic murmur at the left sternal border. Neurologic examination reveals decreased sensation to light touch and vibration in the lower extremities; no depression noted. The hematology consultant on call is asked to see this patient because of a low hematocrit level. Megaloblastic anemia is suspected. Which of the following vitamin deficiencies is the probable cause of this presentation? Discuss each option and note which deficiency is the most likely.

Discuss how this vitamin deficiency impairs purine or pyrimidine metabolism.

List potential laboratory tests and findings that would assist in your differential.