How to manage pedal edema in elderly patients?

Question

Hello doctor,

I am 60 years old, and my current weight is 97 pounds. My height is 5.6 feet. I have had diabetes for the past 25 years. For the last 80 days, I have been on a low-carbohydrate diet, and I am not taking any diabetes medication now. My blood sugar levels are under control, and I monitor them daily.

For the past 50 days, I have had swelling in my feet and ankles. The swelling goes away in the morning but returns by evening. There is no pain and no recent weight loss.

I have already done the following tests: Kidney function, liver function, 2D echo, thyroid function, HbA1C, lipid profile, stool examination, and Vitamin B12. My B12 level was 1271.

A local doctor examined me and suspected nutritional pedal edema or malabsorption. He prescribed the following medications:

Oroalbumen powder three times a day for 30 days.
Revidox LB twice a day for five days.
Lasilactone 25 mg once in the morning for three days.

In addition, I am taking Thyronorm 25 mcg, Vitamin C, a multivitamin tablet, Omega-3 fish oil, and Ecosprin 75.

It has been three days since I started the treatment, but I have not noticed much improvement yet.

My question is:

Why is Vitamin B12 high?
Could this be small intestine bacterial overgrowth?
Taking lots of protein and healthy food, but it is of no use. Could you please help get the food absorbed?

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and can understand your concern.

High vitamin B12 can result from multiple causes. Since your liver function test, kidney function test, peripheral blood smear, etc., are normal (attachment removed to protect patient identity), we can rule out these as the cause. Other causes like diabetes (which you have, as evidenced by HBA1c), non-vegetarian diet (do not know your status), and vitamin supplementation (which you are on) can also cause mild elevations. Small intestinal bacterial overgrowth results in vitamin B12 deficiency.

I hope this helps.

Kindly revert in case of further queries.

Thank you.