Which of the following is a negative prognostic indicator for PLE?

• A. Hypocobalaminemia
• B. Hypercalcemia
• C. Hyperglycemia
• D. Hypokalemia

Answer: (A)

Prognosis in protein-losing enteropathy is closely tied to the level of nutritional and mucosal integrity, especially cobalamin status. Cobalamin (vitamin B12) absorption occurs in the distal small intestine and requires an intact ileal mucosa and adequate pancreatic enzymes. When hypocobalaminemia is present, it signals substantial mucosal disease, ileal involvement, or bacterial overgrowth, all of which reflect more severe intestinal dysfunction. This broader intestinal impairment tends to predict a poorer response to therapy and shorter survival, making low B12 a strong negative prognostic indicator.

The other abnormalities can occur with PLE or related conditions but don’t as reliably indicate prognosis. Hypercalcemia often points to other processes such as concurrent neoplasia; stress-related or other hyperglycemia is nonspecific; electrolyte losses like hypokalemia reflect severe diarrhea but aren’t as predictive of overall outcome as cobalamin deficiency.