The effect of sublingual administration of crystalline vitamin B12 in tropical sprue.

By RAM6N M. SUAREZ, M.D., JUAN SABATER, M.D., RAM6N M. SUAREZ, .JR., M.D. AND ROBERTO BUSO, M.D. S PIES and his collaborators,’4 from Cuba and Puerto Rico, as well as several other investigators in various parts of the world, have proved defiusitely the efficacy of vitamin B12 administered intramuscularly in the treatment of sprue. The usual chitsical and hematologic signs and symptoms of acute sprue respond rapidly and dramatically to the pareisteral admitsistration of vitamits B12. The neurologic complications which occasionally occur its sprue are also controlled or prevented by the intramuscular administratiots of small doses of the vitamin. Oral administration of vitamin B12 has, in our experience, failed to be of atsy value in the treatment of sprue when given in daily doses of 25 mg. and in single oral doses of 100, 500, and as much as 1000 big. In common with Ungley et al.,5 we have nevertheless obtained good clinical and hematologic remissions with the oral administration of single doses of 3000 g. and have even obtained maximal responses when 5000 g. were givets. It is well known that certain drugs and hormotses are readily absorbed when administered subhingually and that their actiots through this route is as rapid and practically as effective as when given paretsterally. This fact led us to study the effect of crystalline vitamin B12* administered sublingually to sprue patients. Five patients showing all the criteria for a diagtsosis of eitlser acute sprue or sprue in relapse w-ere studied. During the period of observation all cases were kept ots an inadequate diet, low in atsimal proteins and its vitamins. This diet, which we have called in previous commutsications “preliminary sprue diet,” is made up almost eistirely of polished rice and kidtsey beans with codfish and vegetables; one cup of coffee w-ith milk was given daily, and there was a weekly allowance of one or two eggs. A daily dose of 25 g. was givets to all 5 patietsts for a period of tets days. The administratiots of the vitamin was closely supervised by one or other of the authors to be sure that the tablet was not swallowed by the patietst but allowed to dissolve slowly under the tongue. Treatment was started whets basal figures for red blood cells, hemoglohits atsd reticulocytes had been reached aisd all necessary clitsical aisd laboratory itsvestigations, itscluding boise marrow studies, gastric analysis, gastroiistestiisal x-rays, glucose tolerance curve, etc., had been performed. This period of observatiOIs usually lasted from seven to ten days.