A client states that she is afraid of receiving vitamin B12 injections because of the potential toxic reactions. What is the nurse’s best response to relieve these fears?
A. “Vitamin B12 will cause ringing in the ears before a toxic level is reached.”
B. “Vitamin B12 may cause a very mild skin rash initially.”
C. “Vitamin B12 may cause mild nausea but nothing toxic.”
D. “Vitamin B12 is generally free of toxicity because it is water soluble.”
Correct Answer: D. “Vitamin B12 is generally free of toxicity because it is water soluble.”
Vitamin B12 is a water-soluble vitamin. When water-soluble vitamins are taken in excess of the body’s needs, they are filtered through the kidneys and excreted. Vitamin B12 is considered to be nontoxic. Adverse reactions that have occurred are believed to be related to impurities or to the preservative in B12 preparations.
Option A: Ringing in the ears is not an adverse effect of Vitamin B12. Cobalamin has many cellular effects with the greatest impact on new blood cell generation and neurological function. At the cellular level, cobalamin acts as a cofactor of two enzymatic reactions that involve methionine synthase and methyl- malonyl-co A mutase.
Option B: Effective therapy may reverse the laboratory abnormality quickly within 24 hours and reestablishment of normal bone marrow hematopoiesis within 48 hours. The reticulocyte count may increase after 3 to 4 days and reach its peak level after one week. A complete blood count may become normal approximately within eight weeks.
Option C: Nausea is not considered to be related to vitamin B12 administration. Compliance with cobalamin supplementation should be monitored in vitamin B12 deficient patients. If the homocysteine or methylmalonic acid level fails to return to a normal level during the first week of treatment, it is suspicious for an incorrect diagnosis.
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