A common complication of lymphangiectasia is hypocobalaminemia; what is the appropriate management?

• A. Vitamin B12 supplementation
• B. Vitamin D supplementation
• C. Calcium supplementation
• D. Folate supplementation

Answer: (B)

Hypocobalaminemia in lymphangiectasia results from loss of cobalamin–binding proteins and B12 itself with the protein-losing enteropathy caused by dilated intestinal lymphatics. The appropriate management is to replace vitamin B12, typically through parenteral (intramuscular) injections to ensure adequate absorption despite mucosal disease. This directly corrects the deficiency and helps prevent hematologic and neurologic complications. Other nutrients listed do not address B12 deficiency; vitamin D and calcium relate to fat-soluble and mineral balances, while folate would not resolve B12-related issues and could mask ongoing B12 deficiency if given alone.